An Analysis of Formal Patient Complaints and Malpractice Events Involving Hand and Upper Extremity Surgeons

Abstract

Introduction: Our purpose was to define and categorize patient complaints within a hand surgery practice over a 10-year period. In addition, we aimed to define surgeon and patient factors associated with formal complaints. Methods: All patients who filed a complaint with our institution's patient advocacy service against six hand surgeons in an academic practice over a 10-year period were recorded and categorized using the Patient Complaint Analysis System. A control group consisting of all patients seen by the surgeons during the study period was created. Demographic differences between the complaint and control groups were analyzed, as were complaint rates between surgeons. We obtained the number of malpractice events involving each of the surgeons. Results: During the 10-year study period, 73 of 36,010 unique patients seen (0.20%) filed a complaint. Care and treatment category comprised the highest percentage of complaint designations (30%), followed by access and availability (23%). Forty-three patients (59%) who filed complaints were treated surgically. Patients with a complaint had a significantly higher percentage of mental, behavioral, or neurodevelopmental disorders compared with controls (55% versus 42%, P = 0.03). The complaint rate (total complaints/total new patients seen) ranged between 0.09% and 0.29% for the six surgeons, and these results were not statistically significant. Discussion: Within an academic hand and upper extremity surgery practice, the rate of patient complaints is 0.20% or approximately one complaint for every 500 new patients seen. Most patient complaints are categorized within the care and treatment domain. Underlying mental health conditions are associated with more frequent complaints. Communication issues appear to represent a modifiable area that hand surgeons can improve to help mitigate potential complaints. Understanding both the frequency and types of patient complaints may allow hand surgeons to recognize areas for improvement and avoid potential exposure to malpractice litigation. Level of Evidence: Prognostic level III (case-control)

Formal Patient Complaints and Malpractice Events Involving Orthopedic Spine Surgeons

“…This compares to a 0.20% complaint rate among hand and upper extremity surgeons and a 0.15% complaint rate among pediatric orthopedic surgeons, which have been previously reported by our group. 6,8 These data are consistent with results from Dambrino et al, 9 who demonstrated that spine neurosurgeons had an increased risk of complaints compared with other physicians. Our overall malpractice event rate among the six surgeons was found to be 0.23%.…”

“…Interestingly, while prior series have shown the association between patient demographics (obesity, tobacco use, and worker’s compensation) and surgical complications, these were not associated with complaints in our series or prior similar studies of other orthopedic subspecialties. 6,8,16–18…”

“…All six surgeons were fellowship trained in orthopedic spine surgery. We utilized a methodology similar to that described by Grandizio et al 6 for this study.…”

“…Interestingly, while prior series have shown the association between patient demographics (obesity, tobacco use, and worker's compensation) and surgical complications, these were not associated with complaints in our series or prior similar studies of other orthopedic subspecialties. 6,8,[16][17][18] This study has several limitations. The retrospective nature of this study limits the ability to legitimize each patient complaint, meaning that all complaints were weighed equally regardless of their credibility.…”

“…The two most common complaint domains in this study were access & availability and care & treatment, which is consistent with prior reports. 6,8 Nearly one-third of the complaints pertaining to access and availability were due to appointment scheduling delays. It may be prudent for healthcare systems to adequately staff providers and schedulers within their practices to improve access and availability to spine surgeons.…”