An Inadequate Patient Assessment Increases the Risk of a Malpractice Defendant Being Held Responsible

The odds of an MPL case closing with an indemnity payment increase 85% when the patient assessment was incomplete or otherwise inadequate.

According to analysis of 15,927 patient assessment cases from CRICO’s national comparative benchmarking system, 47% closed with payment (compared with 30% for all MPL cases). The average payment was $519,000; six percent of cases closed for a million dollars or more. Surgical and medical specialties were equally exposed; more than half (56%) involved a high-severity injury or patient death.

Half (53%) of these cases were complicated by a suboptimal response to the patient’s clinical signs or symptoms; 36% were undermined by the clinician’s narrow diagnostic focus, and a third hinged on a failure to order a clinically indicated test. The majority of patient assessment cases stem from care in an outpatient setting: 47% in office-based care and 14% in the Emergency Department.

Assessment errors are at the root of a high proportion of high-impact adverse events because they frequently lead to subsequent missed opportunities to course correct the patient’s care. When an adverse event resulting in a high-severity injury or death is linked to critical information that was missing or misleading, the likelihood of a case closing with indemnity payment increases.

Key considerations for interventions to reduce this risk include:

• Review the role of the history and physical
• Aid in the creation of a concise patient summary/profile
• Review the role of decision support tools
• Consider the role of all team members during the assessment process
• Be sensitive to the impact of time constraints
• Guide a manageable differential diagnosis list
• Promote smarter testing
• Address operational/environmental factors that may narrow the assessment process

To better understand your organization’s specific policy/protocol vulnerabilities, consider:

• Which missed diagnoses are most problematic?
• Which category of tests are most commonly not ordered/delayed?
• Which specialty consults/referrals are most commonly delayed?

Also included in the full report, The Power to Predict, are strategies for defendingMPL cases with inadequate patient assessments.

Additional Materials

• Reexamining the physical exam
• The importance of the history and physical in diagnosis
• Using the ABCDE approach to assess the deteriorating patient
• Scorecards that save lives
• Checklist: a review of their origins, benefits, and current uses as a cognitive aid