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December 18, 2019

How Can Practices Mitigate the Most Common Diagnostic Errors that Lead to Malpractice Claims Against Physicians?

By Thomas J. Bryant, ARM
President, Physicians Insurance

Missed diagnosis, delayed diagnosis, and wrong diagnosis comprise the most common diagnostic error categories, and diagnostic errors in general comprise the most common type of allegation in malpractice claims.

Clinical judgment is found to be the most common contributing factor in 80 percent of diagnosis-related claims, according to MedPro closed claim data. However, clinical judgement can comprise a wide spectrum of possible errors in cognition, decision-making, processes, environmental and personal distractions, fatigue and much more.

The MedPro data suggests that one factor emerges as particularly relevant. In clinical judgement errors, patient assessment issues are the top problem as cited in claims data.

Let’s take a closer look. How can physicians use this insight about patient assessment to mitigate risk at the point of patient care? Put simply — by placing an emphasis on better systems and better teamwork practice-wide.

Research from the Institute of Medicine (IOM) in the published report Improving Diagnosis in Health Care offers recommendations. The top recommendation was to promote teamwork to strengthen diagnosis process — distributing the diagnostic process across the “diagnostic team.”

In addition to strengthening teamwork across teams, the IOM also recommended adding series of integrations throughout the clinical workflow such as: evidence-based decision support systems like CDSS, clinical guidelines, use of checklists, evaluating the use of clinical pathways, and building awareness of cognitive and affective biases amongst other tools, all of which can help support the decision-making process.

Among the recommendations made by the IOM were:

• Health IT vendors should meet standards of interoperability among different health systems to support efficient and effective patient information flow.
• Organizations should facilitate better teamwork not only between healthcare professionals, but also improved collaboration with patients and their families during the diagnostic process, by ensuring patient and family access to diagnostic criteria and EHR materials.
• Leaders should develop and define clinical pathways and care plans for use across multidisciplinary teams that monitor the diagnostic process so as to better identify, learn from and reduce diagnostic efforts.
• Educators should enhance healthcare professional education  — in the form of CME, reviews of current practices within healthcare organizations, and research of clinical data — to address performance in diagnostic settings as well as build awareness of cognitive and affective biases

Insurers are becoming aware of these new needs and malpractice carriers are retooling to focus educational offerings and risk management support on the issues which data analytics show are root-cause areas. This business intelligence can ultimately assist physicians to better manage risks, and ultimately improve outcomes and costs.

Thanks so much for reading. If you’d like to read the complete set of IOM recommendations, they can be found here.

I can also recommend some further reading on the topic, listed below:

Coverys article on Clinical Decision Support Systems (CDSS):
https://www.coverys.com/knowledgecenter/Blogs/Reduce-Diagnostic-Errors-With-Clinical-Decision-Su

Society To Improve Diagnosis In Medicine’s Clinical Reasoning Toolkit:
https://www.improvediagnosis.org/clinicalreasoning/

Clinical Judgment in Diagnostic Errors: Let’s Think About Thinking, by Laura M. Cascella:
https://www.medpro.com/documents/10502/2820774/Article_Clinical+Judgment.pdf

Physicians Insurance President Thomas J. Bryant, ARM, is a licensed Property, Casualty, Life, Accident and Health broker in all six New England states and has been an adjunct clinical assistant professor in the School of Health Sciences at Bryant University since 2016. Tom is currently studying at MIT Sloan School in the Innovation track of their Executive Education program. Most recently Tom developed a video presentation on malpractice issues, for Harvard Medical School 4th year students, and has participated in NEJM Resident 360 virtual panels on topics related to financial matters important to early career physicians.

Is it time to examine your current policy? What you don’t know can hurt you. For more information on how Physicians Insurance can support your practice and help you mitigate risk, call 800.522.7426.