Lawsuits identifying nurses as the primary provider in the ED were rare overall (408 of more than 54,000 claims), according to an analysis of medical malpractice claims data gathered between 2007 and 2016.1

“Medical malpractice data can be used to target patient safety efforts in healthcare,” says Laura Myers, MD, MPH, CPPS, the study’s lead author and a research scientist at Kaiser Permanente Northern California.

Previous research identified the issues arising most commonly in medical malpractice claims involving critical care physicians.2 “But little has been published describing claims in which nursing was the primary provider in the claim,” Myers notes.

Myers and colleagues analyzed claims with nursing identified as the primary provider in a large database of paid and unpaid malpractice claims. They examined three specific settings: The ICU, the ED, and the OR. “These locations were used because they are all fast-paced, high-stakes settings,” Myers reports.

Malpractice claims in the three settings each featured distinct themes in terms of harm severity, allegations, final diagnosis, and contributing factors. “Understanding the themes of the harm events that arise in a given location can best direct patient safety efforts to prevent similar events from happening in the future,” Myers offers. Some results from the claims:

  • Claims involving ED nurses most commonly resulted in only temporary harm (55%) and less commonly involved a procedure (28%) vs. claims from the ICU and OR.
  • Claims involving ED nurses were less likely to be paid on behalf of any defendant.
  • The vast majority of claims involving nurses in the ED (93%) named the hospital as a co-defendant.

“Because patients in the emergency department have such a wide variety of diagnoses, it wasn’t clear what to expect in terms of the most common diagnosis,” Myers says.

As she and colleagues expected, decubitus ulcers was the most common diagnosis in the ICU claims. They were not sure what to expect from the ED claims. “As it turns out, vascular complications were quite common in the emergency department, which was an interesting finding,” Myers says.

Further research is needed to understand what types of vascular complications occur in claims involving ED nurses. It is unclear whether the claims involved IV infiltration, thrombophlebitis, pain caused by multiple sticks, or inadvertent arterial placement. “Prevention efforts might include procedural training, integration of ultrasound in IV placement, or escalation of patients with difficult access to providers who specialize in IV access,” Myers says.


  1. Myers LC, Heard L, Mort E. Lessons learned from medical malpractice claims involving critical care nurses. Am J Crit Care 2020;29:174-181.
  2. Myers LC, Skillings J, Heard L, et al. Medical malpractice involving pulmonary/critical care physicians. Chest 2019;156:907-914.