The Quality of Upper Extremity Orthopedic Care in Liability Claims Filed and Claims Paid

Matsen, Frederick A.; Stephens, Linda S.; Jette, Jocelyn L.; Warme, Winston J.; Huang, Jerry I.; Posner, Karen L.

doi:10.1016/j.jhsa.2013.10.014

Cited by 10 publications

(13 citation statements)

References 30 publications

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“…It contributes a substantial amount to the overall cost of health care in the United States through indemnity payments, lost wages as a result of patient injury, and the practice of defensive medicine, which appears to be a common practice overall and specifically within orthopaedics. 1,2,[8][9][10][11][12] The risk of facing a malpractice claim appears to differ based on medical subspecialty, with surgical subspecialties having the most risk. 13 Previous work examining the structure of the liability system has found variability in risk exposure of physicians based on scope of practice, location of practice, with speculation that patient demographics, specifically the age of the patient also effects risk variability.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice

Oetgen

Parikh

2016

Journal of Pediatric Orthopaedics

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Section: Discussionmentioning

confidence: 99%

Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice

Oetgen

Parikh

2016

Journal of Pediatric Orthopaedics

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“…Fracture fixation has been reported as the one of the most common orthopaedic surgical procedures leading to malpractice allegations. [ 11 ] The analysis of fracture claims data in this study attempts to compare the characteristics of claims to the fracture type and fracture management. The ultimate goal of this analysis is to identify specific targets to improve patient safety and reduce litigation events.…”

Section: Discussionmentioning

confidence: 99%

Increased litigation burden among tibia, pelvis, and spine fractures

Naga

Slocum

Tucker

et al. 2019

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: To analyze a series of claims from a large national malpractice insurer associated with fracture care to understand what parameters are associated with claims, defense costs, and paid indemnity. Design: Review of claims in fracture care settings from a national database; case series. Setting: Database draws from insured pool of 400,000 medical malpractice cases from 400 healthcare entities across the country, representing 165,000 physicians; both academic and private. Patients/Participants: Fracture care patients bringing legal suit. Main Outcome Measurements: Cost of legal proceedings and indemnity, ICD-9 codes, and contributing causes toward claims. Results: A total of 756 fracture claims were asserted between 2005 and 2014 regarding fracture care within the database; 70% were brought for inaccurate, missed, or delayed diagnosis, while 22% addressed medical treatment and 8% were for surgical management. Orthopaedics was the primary service in 22%. Total cost (expenses and indemnity) to orthopaedic providers totaled $13.1MM (million). The most common claim against orthopaedics was for fractures of the tibia and fibula (11.4%). Impact factor (IF) analysis (as described by Matsen) of indemnity in these cases reveals 3 fracture regions of highest indemnity burden: fractures of the tibia and fibula (IF: 1.86, 11.4%), pelvis (IF: 1.77, 6.6%), and spine (IF 1.33, 6.6%). Analysis of contributing factors identifies the category of clinical judgement as the most common category (62%). Other common factors include patient noncompliance (31%), communication (28%), technical skill (17%), clinical systems (11%), and documentation (10%). The single most common specific cause of a claim in orthopaedic fracture care was misinterpretation of diagnostic imaging (25%). Conclusion: This study is the first of its kind to identify fractures of the tibia and fibula as high risk for litigation against orthopaedic providers and provides general counseling of legal pitfalls in fracture care. Finally, we are able to identify the act of patient assessment as a key issue in over half of all fracture-related claims against orthopaedic providers. Providers in general and specialty settings can use this information to help guide their treatment and care ownership decisions in the care of patients with fractures. Level of Evidence: Economic - Level III.

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“…Matsen et al [17] suggested that the incidence of claims due to wrist fractures and claims paid could be reduced if surgeons acquire and maintain the knowledge and skills necessary for the care of the common conditions they encounter, including fractures. In Norway, senior clinicians are regularly offered a four-month period every 5 year for professional upgrading/training and most of them take part in at least one course/international conference per year.…”

Section: Discussionmentioning

confidence: 99%

Wrist malpractice claims in Northern Norway 2005–2014. Lessons to be learned

Norum

Balteskard

Thomsen³

et al. 2018

International Journal of Circumpolar Health

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Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation were “operative treatment should have been performed” (14/34) and “wrong operative method applied” (13/34). The mean amount per compensation was €14,927 (€0–€52,995). Stonger focus on quality of care, updated guidelines and shared decission-making may reduce the number og complains and compensations.

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The Quality of Upper Extremity Orthopedic Care in Liability Claims Filed and Claims Paid

Cited by 10 publications

References 30 publications

Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice

Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice

Increased litigation burden among tibia, pelvis, and spine fractures

Wrist malpractice claims in Northern Norway 2005–2014. Lessons to be learned

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