Comparison of Emergency Medicine Malpractice Cases Involving Residents to Nonresident Cases

Abstract

There are higher total incurred losses in nonresident cases. There are higher severity scores in resident cases. The overall case profiles, including allegation categories, final diagnoses, and contributing factors between resident and nonresident cases are similar. Cases involving residents are more likely to involve certain technical skills, specifically vascular access and spinal procedures, which may have important implications regarding supervision. Clinical judgment, communication, and documentation are the most prevalent contributing factors in all cases and should be targets for risk reduction strategies.

Getting to the heart of the issue: senior emergency resident electrocardiogram interpretation and its impact on quality assurance events

“…Data comparing EM malpractice cases involving residents with cases in which only the attending physicians were named have been reported. 15 In that study, in the resident cases there was a statistically significantly higher percentage of cardiac-related cases than there was in the attending physician-only cases. While that investigation was not specifically focused on ECG misinterpretation or the unique EM3 role described herein, those findings emphasize the importance of honing ECG interpretation skills during residency to improve clinical skills, mitigate errors, and improve patient safety.…”

Beware of Reversal of an Anticoagulated Patient with Factor IX in the Emergency Department: Case Report of a Medical-Legal Misadventure

“…Between 2009-2013, EM residents were named in 13.4% of malpractice lawsuits. 7 In a malpractice lawsuit, four elements must be present: duty; breach of duty; causation; and damages. This standard holds true for both residents and attending physicians who are named in the suit.…”

“…Malpractice cases with residents named were statistically more likely to involve cardiac cases and procedures. 7 The vexing issue regarding residents is this: What standard of care ought they be held to? Historically, from the 1950s-1980s, residents were held to a lower standard of care than attendings.…”

The Effect of Shared Decisionmaking on Patients’ Likelihood of Filing a Complaint or Lawsuit: A Simulation Study

“…We decided to use the clinical scenario of suspected appendicitis for two reasons; first, physicians report using SDM in this scenario, and second, "failure or delay in diagnosis" is the most common reason a lawsuit is filed against an emergency provider. 12,21 The final questionnaire (Supplemental Material A-D) consisted of 6 sections: 1) a vignette describing the patient's presentation to the ED for abdominal pain; 2) one of three possible physician-patient dialogues regarding the ordering of a Computed Tomography (CT) scan of the abdomen/pelvis; 3) a manipulation check to assess whether participants read the dialogue carefully and recognized the aspects of communication presented; 4) the conclusion of the scenario which results in a repeat ED visit and a CT demonstrating ruptured appendicitis (and an explanation of the adverse consequences of the delay in diagnosis); 5) items assessing the participants' response to the scenario and dialogue, in light of the adverse outcome; 6) demographic variables. None of the sections varied other than the second, and each section is described in detail below.…”