Blog & Articles

The Dangerous Discrepancies

One of the most difficult hurdles to overcome during the defense of a malpractice suit is a significant discrepancy in the medical record. The discrepancies may involve the nurses, physicians, advanced practice clinicians, EMS personnel, and any records related to the patient. Often, a discrepancy may be nothing more than a minor difference in terminology; but the cases reviewed here reveal serious discrepancies between the physician and the nurse chart in the first case and the physician and EMS record in the second case.

In a previous posting, “The Ultimate Loss Prevention Strategy: 4 Key Areas of Allocating Your Risk Management Budget,” we highlighted the importance of addressing Diagnosis-Related Adverse Events. As an extension of that article, Dr. Tom Syzek and I provide further detail for justifying that recommendation and the recent data surrounding diagnostic errors, after which we will outline three key attributes of successful initiatives that have led to positive results.

Thoracic aortic dissection (TAD) is one of the most dramatic and life-threatening conditions encountered in all of medicine. Every year in the United States, there are an estimated 6,000 to 10,000 cases of TAD. Since it is an uncommon condition compared to the 5 million ED chest pain visits and more than 1 million acute myocardial infarctions, most physicians have diagnosed and treated only a few patients with TAD during their careers.

Patient experience is an area of healthcare that has a significant impact not only on an organization’s reimbursement, but also on a hospital’s professional liability (HPL) and exposure to litigation. As a result of recent regulatory changes from the Affordable Care Act, it appears that hospitals have become even more judicious in their allocation of resources to various internal initiatives. With this in mind, let’s explore recent evidence that supports a rational, targeted approach for impacting HCAHPS that should lead to an improvement in reimbursement and reduction in liability.

Ever since the Institute of Medicine’s report To Err is Human was released in 2000, healthcare has seen a surge in patient safety initiatives. Analysis of medical errors has become increasingly widespread, with several different methods being used by hospitals and practitioners. Of these methods, I suggest that cognitive error analysis may prove to be one of the most valuable in determining the real underlying reasons for medical errors that lead to unexpected adverse patient outcomes.

As the healthcare industry constantly evolves and “return on investment” remains a focus, it is becoming more imperative that risk managers allocate their budgets in areas that have the greatest impact on mitigating claims and litigation.

Fortunately, The Sullivan Group has the luxury of working with many large, sophisticated, self-insured hospital systems as well as smaller single-site facilities and physician groups. This experience has helped us identify four key areas that an organization should consider when developing its loss prevention strategy.

The healthcare industry will continue to have its radar locked on the issue of Patient Safety in 2017. Some of the targets and goals are only vaguely visible from the 30,000-foot level, while others are in clear focus on the ground before us. Depending on where you stand (or fly), opportunities abound to improve patient safety. Let’s take a forward look into 2017, starting high in the clouds and descending eventually to earth.

We've featured a variety of topics, cases, and missed diagnoses on our blog this year, and we hope that you've found the content useful and relevant.

In case you missed some of 2016's most popular posts, here are the top 10 articles from the blog this year, according to our website visitor statistics. What was your favorite article?

Download infographic as PDF. Content provided in partnership with John West, JD, MHA, CPHRM, DFASHRM.

The majority of malpractice suits in acute care and emergency medicine involve patients who were discharged home.

These patients experienced an unexpected adverse outcome after they left the ED such as worsening of their illness or even death.

For many of these patients, the “bad outcome” could not have been foreseen — the workup was appropriate, the diagnosis and treatment were correct, and the patient was stable for discharge.

A number of discharged patients, however, might have been misdiagnosed and had red flags present at the time of discharge that were either ignored or not recognized.

In some of these patients with adverse outcomes, preventable hospital discharge medical errors existed.