JACR: Communication breakdowns add to growing malpractice costs

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Since 1991, there has been a growing risk for malpractice litigation stemming from a failure to communicate urgent or unexpected clinical findings from diagnostic examinations, according to a study published in the November edition of the Journal of the American College of Radiology.

Brian D. Gale, MD, MBA, of the department of radiology at the State University of New York Downstate Medical Center in New York City, and colleagues wrote that over the past decade clinicians have ordered a rising number of diagnostic exams, and that malpractice payments related to diagnosis during this same time period have increased approximately 40 percent. They wanted to determine how large of a role communication failures played in contributing to these rising costs.

The researchers turned to two sources for data: The National Practitioner Data Bank (NPDB) from the U.S. Department of Health and Human Services and the Controlled Risk Insurance Company/Risk Management Foundation (CRICO/RMF). NPDB data were used to track malpractice award payments for action related to communication failures, while CRICO/RMF data provided deeper insight into the types of communication failures involved in these cases.

Total payouts for the communication-related causes of action studied by Gale et al increased from $21.7 million in 1991 to $91 million in 2010. A linear regression analysis of data from 1991 to 2009 showed an average annual increase in claims payments of $4.67 million.

CRICO/RMF data from 2004 to 2008 showed that communication failures played a role in 306 malpractice cases representing 4 percent of cases by volume and 7 percent of the total cost. The specialty primarily responsible in the most cases of communication failure was medicine, which was involved in 40.1 percent of cases.

Radiologists were the primary responsible defendants in 7.8 percent of cases, behind medicine, ED, surgery and obstetrics/gynecology. A secondary responsible specialty was involved in 181 cases, and here radiologists were identified in 24 percent of cases, the highest percentage of secondary involvement.

The number one contributing factor in cases associated with communication failure was a patient not receiving results or receiving the wrong report, which occurred in 143 cases. Other common contributing factors were clinicians not receiving results and delays in reporting findings.

Researchers speculated that the increase in cases may be the result of increasing societal expectations for reliable communication of clinical data.

“Another explanation may be that the remarkable growth in diagnostic test volume has led to a corresponding increase in reportable results,” wrote the authors. “If notification reliability remained unchanged, this increased volume would predict more failed notifications.”

The authors added that new, commercially available technology may help in efficiently delivering test results to referring clinicians.

“The advent of semiautomated critical test result management systems may improve notification reliability, improve workflow and patient safety, and, when necessary, provide legal documentation,” wrote the authors.