More than a third of medical malpractice lawsuits against hospitalists involve allegations of diagnostic errors, according to a study by national medical liability insurer The Doctors Company published online March 3.

Darrell Ranum , vice president for patient safety and risk management for The Doctors Company, and his colleagues, analyzed 464 claims against hospitalists in the insurer’s database that were closed from 2007 to 2014. The claims involved 2,100 hospitalists insured by The Doctors Company. More than a third of claims (36%) were diagnostic related; they included allegations of incorrect diagnosis, delayed diagnosis, or failure to diagnosis, the study found.

Conditions most commonly associated with incorrect or delayed diagnosis included intestinal disorders, such as obstruction, perforation, and vascular insufficiency (16%), cerebral artery occlusion and acute cerebral vascular accident (7%), acute myocardial infarction, and cardiac arrest (6%). Other conditions linked to diagnostic malpractice claims against hospitalists included sepsis and toxic shock syndrome (5%), pulmonary embolism (5%), spinal epidural abscess (4%), lung cancer (4%), viral and bacterial pneumonia (3%), subacute and acute endocarditis (3%), and aortic dissection or aneurysm (3%).

A surprising finding of the study is the number of uncommon diagnoses connected to frequent malpractice allegations, said Dr. John Nelson , medical director for the hospitalist practice at Overlake Hospital in Bellevue, Wash., and cofounder of the Society of Hospital Medicine. The connection between spinal epidural abscess and lawsuits for example, shows that such patient cases pose a greater legal risk than other conditions, he said.

“If every patient posed an equal risk of leading to a malpractice claim, you would expect the claims to mirror the frequency of illness,” Dr. Nelson said in an interview. “But they don’t. That suggests that [certain] diseases are riskier for hospitalists from a medical-legal perspective.”

Among the other claims, 31% related to improper treatment management, 11% claimed medication errors, and 5% alleged improper performance or delay in treatment or procedure.

The study also analyzed top factors that contributed to patient injury by hospitalists. Patient assessment issues, such as to failure establish a differential diagnosis, were the most common contributor at 35%. Communication breakdowns among providers, such as poor transfer of information between doctors and nurses, were the second-most-frequent contributor at 23%. Other factors were selection and management of therapy (16%), communication issues between health providers and patients/family members (12%), failure to obtain a consult or referral (12%), and patient factors (12%). (Claims could have more than one contributing factor.)

Claims arising from hospitalist care were likely to involve greater patient injury severity than other physician specialties, the study found.

The study underscores the importance of developing positive relationships with patients and strengthening communications between specialists, Dr. Nelson said.

“Build rapport with patients,” he said. “Communicate well. Make sure it’s safe if you’re gong to wait and see how things go [overnight] with a patient. If you’re not so sure, perhaps it’s better to act quickly.”


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