Objectives Objectives Understand types of malpractice insurance - - PDF document
Richard O. Davis, MD 2/14/2017 Tips for Optimal Management of Tips for Optimal Management of Risk in Obstetrical Care Risk in Obstetrical Care Richard O. Davis, M.D. Richard O. Davis, M.D. Objectives Objectives Understand types of
Understand types of malpractice insurance
Discuss the importance of risk management in the
Understand pitfalls in the Electronic Medical
Discuss recent trends in medical malpractice
Assessment: Understand the
Assess level of risk Standard of care (internal and/or
Individual practitioner(s) or system(s) Focus on resolution and quality
Incident Reports at UAB are Electronic.
Never refer to an Incident Report in the
Never Place an Incident Report in the
Never Document your conversation with
Never email or text following an adverse
Injury
Death
7
Death
Children
PIAA
* 60 were birth injury cases (all exceeded $5 million)
The Risk Authority Stanford University Medical Network
2013 Rank Company Not Previous Written 1 Berkshire Hathaway 825.5 M 2 Doctors Company 736.1 3 MLMIC (NY) 542 4 Pro Assurance 494 9 4 Pro Assurance 494.9 5 CNA 477.2 6 PRI (NY) 373.2 7 AIG 351.5 8 Coverys 346.2 9 NORCAL 285.7 10 ISMIE Mutual (llinois) 243.2
Source: AM Best 2014
About 1 in every 3,711 births results in
Average value of these cases including
Average value of these cases, including
The cost per delivery to cover liability is,
Source: Berkley Med 2015 Source: Berkley Med 2015
Failure to Diagnosis Fetal Distress
Failure to Timely perform Cesarean
Surgical Care
Shoulder Dystocia
Source: Berkley Med Source: Berkley Med
Improper Performance
Errors in Diagnosis
Failure to Supervise or Monitor Care
Medication Errors
Internal Medicine
Obstetrics and Gynecology
General Surgery
General Surgery
General Practice/Family Medicine 11% Orthopedics
16% of physicians had at least 2 paid
4% of physicians had at least 3 paid 4% of physicians had at least 3 paid
1% of physicians had at least 4 paid
2 paid claims = 1.97 hazard ratio
3 paid claims – 3.11 hazard ratio 6 or more paid claims = 12.39 hazard
Neurosurgeons = 2.32 hazard ratio Orthopedic surgeons = 2.02 hazard
Obstetrician-Gynecologist – 1.89
Psychiatrists and Pediatricians - <1
Only 6% of physicians had a paid
1% of physicians with ≥ 2 paid claims
0.2% of physicians with ≥ 3 paid
Some malpractice payments do not reach the
Settlements made in name of an institutional co-
Shielding is most likely:
Retrospective, cohort study of claims
CBS: National Malpractice Claims Database
CBS: National Malpractice Claims Database
147 (<1%) had 1 or more HER errors as
Graber, et al. J Patient Safety, 2015 Graber, et al. J Patient Safety, 2015
Medication errors
Diagnosis errors
Treatment complications
Treatment complications
Issues Identified
Graber, et al. J Patient Safety, 2015 Graber, et al. J Patient Safety, 2015
User related: copy forward/paste, auto
Technology related: transition from paper to
Graber, et al. J Patient Safety, 2015 Graber, et al. J Patient Safety, 2015
Labor induction
39 weeks
Diabetes
Diabetes
Spontaneous delivery
Shoulder dystocia
Brachial plexus injury
Indication for induction
Type of diabetes and control
Estimated fetal weight
Estimated fetal weight
Discussion of possible shoulder dystocia
Cesarean discussed?
Head to body delivery interval
Maneuvers
Anterior shoulder (
Anterior shoulder (
Discussion with patient/family
Acknowledge: weak arm, fracture
Failure to diagnose (Cancer, ectopic) Follow-up of mammogram, PAP smear, lab Bladder, ureter, bowel injury Retained laps/sponges, instruments
Failure to follow up on Lab Tests, outside
May result in Delays in Treatment and
Failure to communicate leads to
Patient to Healthcare Provider
Patient to Healthcare Provider
Nurse to Resident
Resident to Upper Level Resident
Resident to Attending
Attending to Attending