Risk Management and Healthcare Policy (Feb 2024)
Analysis of Closed Claims Among All Medical Specialties: Importance of Communication and Other Non-Clinical Contributing Factors
Abstract
Fred Kusumoto,1 Jacqueline Ross,2 Dan Wright,2 Richard A Chazal,3 Richard E Anderson2 1Heart Rhythm Service, Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL, USA; 2The Doctors Company, Napa, CA, USA; 3Lee Health Heart and Vascular Institute, Fort Myers, FL, USACorrespondence: Fred Kusumoto, Heart Rhythm Service, Department of Cardiovascular Disease, Mayo Clinic, 4500 San Pablo Ave, Jacksonville, FL, 32224, USA, Tel +1904 953-7277, Email [email protected]: Medical malpractice claims represent patient dissatisfaction of care delivered by their healthcare provider. Evaluation of contributing factors (CFs) associated with claims provides important information to optimize the patient–provider relationship.Study Design: A total of 21,101 closed claims with 54,479 CFs (2.2 contributing factors per claim) from a large medical professional liability coverage provider were analyzed from 2010 to 2019.Results: Four clinical CFs (technical performance, management of therapy, patient assessment, and patient factors) and four nonclinical CFs (communication between providers and patient, communication among providers, failure or delay in obtaining a consult, and insufficient documentation) were identified > 1,500 times. Nonclinical CFs increased as a percentage from 50% in the first part of the study period to 54% in the second part of the study period (p < 0.01), and were more frequent in cases associated with indemnity when compared to clinical CFs (Nonclinical: 57% vs 43%; p < 0.001). Poor communication as a CF increased steadily during the study period (3-year average; 2010– 2012: 777 CF/year vs 2017– 2019: 1207 CF/year; p < 0.001). In claims associated with high severity injury, poor communication among providers was more significant than poor communication between the provider and patient (63% vs 29%; p < 0.001), mainly due to failure to convey the severity of the patient’s condition. For non-surgical specialties except psychiatry, communication was the highest CF and the second or third CF for psychiatry or surgical specialties.Discussion: Clinical and nonclinical CFs are equally important for malpractice claims. Communications issues are particularly important regardless of specialty. While focusing on clinical quality is important, implementing strategies that account for nonclinical issues, with a particular focus on communication, would have significant benefits particularly in an environment of increased consolidation of healthcare delivery systems.Plain Language summary: Nonclinical and clinical issues are equally common contributors underlying a malpractice claim, and nonclinical issues are more frequent in claims associated with indemnity.Communication-related (communication between the patient and the healthcare provider and communication among providers) contributing factors were the most observed nonclinical parameter and the incidence has steadily risen over the study decade.Current strategies in healthcare to improve communication have not been effective and developing systems and strategies that focus on communication and other nonclinical issues could significantly decrease future malpractice claims.Keywords: closed claims, malpractice, professional liability, communication
