Medical Malpractice Claims Involving Physicians in the Intensive Care Unit: A Cohort Study

Abstract

Background: The intensive care unit (ICU) is a fast-paced setting, in which physicians from different specialties work. The goal of this study is to understand whether characteristics of medical malpractice claims occurring in the ICU differ by physician specialty. Methods: A retrospective cohort study was performed using a national database called the Comparative Benchmarking System, which is operated by Harvard’s malpractice insurer. Claims were included if the harm events occurred in the ICU and closed between 2007-2016. Claims were analyzed according to physician specialty of the “primary responsible provider,” which was the physician most directly involved in the harm event. Patient-, provider- and claim-level characteristics were compared among the 6 most common physician specialties that were identified as “primary responsible provider.” Multivariable regression was performed to identify factors associated with claim payment. Results: Of 54,772 claims, 1,113 resulted from harm events in the ICU, of which 843 involved the following physician specialties: internal medicine (305), cardiology (163), pulmonary medicine (149), general surgery (98), neurology (97) and anesthesia (31). The minority of claims across physician specialties originated in academic medical centers (<30%). The most common severity of harm was death (Range 42-72%, P = 0.0001). The frequency with which claims involved procedures varied by physician specialty (Range 24-84%, P < 0.0001). The 3 most common contributing factors (patient assessment, selection/management of therapies and communication among providers) did not differ by physician specialty. In multivariable regression, claims that were procedure-related were statistically more likely to result in payment (Odds Ratio 2.29, 95% Confidence Interval 1.64-3.20), after adjusting for physician specialty. Conclusions: There were few unexpected differences in malpractice claims occurring in the ICU by physician specialty. Prevention efforts could focus on procedures, regardless of physician specialty, including: 1) maintaining procedural skills, 2) framing procedural risks well and 3) accurately describing procedural complications after they happen.

The Government as Plaintiff: An Analysis of Medical Litigation Against Healthcare Providers in the Eastern Province of the Kingdom of Saudi Arabia

“…These studies reached mixed conclusions on the impact of the number of codefendants on medical litigation. A few studies have concluded that the number of codefendants was not a significant predictor of defendants’ verdicts, 31 nor was it a significant predictor of the amount of compensation paid for patients in claims against medical intensive care unit physicians 45 . Conversely, analyzed medical malpractice cases in Texas found that more than 50% of cases with high paid compensations included 2 or more codefendants.…”

“…Only a few previous studies have included the number of codefendants as part of analyzing medical litigation. 31,44,45 These studies reached mixed conclusions on the impact of the number of codefendants on medical litigation. A few studies have concluded that the number of codefendants was not a significant predictor of defendants' verdicts, 31 nor was it a significant predictor of the amount of compensation paid for patients in claims against medical intensive care unit physicians.…”

“…In addition, guilty HCPs accused in violation claims with multiple defendants were more likely to receive a warning rather than a fine. Only a few previous studies have included the number of codefendants as part of analyzing medical litigation 31,44,45 . These studies reached mixed conclusions on the impact of the number of codefendants on medical litigation.…”

How Data Can Drive Initiatives to Improve Patient Safety and Reduce Risk

“…In the first example, Ranum et al (2021) review anesthesia-related cases in ambulatory surgery settings. Myers (2021) focused her examination on cases against physicians in the intensive care unit. Finally, Prieto et al (2022) analyzed cases involving pediatric surgery cases.…”

“…Another study that focused on a specific set of providers in a particular setting was conducted by Myers (2021), who evaluated cases against physicians in the intensive care unit (ICU) over a 10-year period. The CBS data included 1,113 cases involving injury claims specific to physicians in the ICU, which were further analyzed by comparing the specialty of each primary physician named in the case.…”