Original Article

Analysis of Diagnostic Error in Paid Malpractice Claims with Substandard Care in a Large Healthcare System

Authors: Thomas V. Holohan, MD, Janice Colestro, DNS, RN, John Grippi, MD, Jane Converse, JD, Michael Hughes, BMET


Objective: Although claims databases are not representative of all care delivery, their predisposition toward serious unintended injury can complement resource-intensive chart reviews and guide patient safety initiatives.

Materials and Methods: Non-Veterans Health Administration (VA) practitioners reviewed 1,949 VA malpractice claims paid during fiscal years 1998 through 2003. The portion associated with substandard care, the severity of harm, and types of negligence were identified.

Results: Negligent adverse events occurred in 37% (n = 723) of paid VA malpractice claims. These had high proportions of serious injury (55%) and morbidity (37%). Diagnostic negligent adverse events were most frequent (45%) and with 41% associated morbidity. The annual incidence of diagnosis-related paid VA malpractice claims was 1.95 per 100,000 patients and predicts that 122 of every 100,000 patients may have diagnostic negligent adverse events. Comparisons against non-VA data suggest this to be a healthcare industry problem.

Conclusions: Diagnosis-related negligent adverse events are a serious problem in the healthcare industry.

Key Points

* Medical records of Veterans Health Administration paid claims are reviewed by non-Veterans Health Administration practitioners to determine the presence of substandard care for purposes of reporting to the National Practitioner Data Bank.

* Negligent or substandard care was found in 37% of all paid claims.

* When substandard care occurred, adverse events suffered by patients were severe.

* Categorization into negligence classifications established by the National Practitioner Data Bank revealed that diagnostic error was the most frequent error type and was also associated with a high proportion of fatal outcomes.

* Review of malpractice cases complements medical record reviews of adverse events and provides an opportunity to focus on serious errors and to institute corrective actions to improve quality of care.

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