Breakdown of percentage of claims against radiologist from a malpractice perspective ie ER, IP, OP

10 November 2019 - Collaborative Imaging
radiologist worried about a risk of a malpractice
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While literature based on errors made in radiology and the malpractice cases that may result is prevalent, information related to systematic reviews of the actual malpractice claims is lacking. However, on Aug. 27, 2019, the Journal of the American College of Radiology published the study, Emergency Radiology: An Underappreciated Source of Liability Risk. According to this study, nearly 50 percent of all the malpractice claims related to radiology involve patients who received treatment in the emergency department/emergency room.

Malpractice Claims Against Radiologists: Inpatient, Outpatient and Emergency Room Patients

The authors of the study explored imaging examinations that spanned 18 states. All the 149 radiology images studied were from cases that took place at some point between 2012 and 2019. The evidence used for the study was attained from a platform in Seattle called Cleareview.  Other data reviewed included Medicare data. The researchers used this data to locate the number of imaging examinations that were performed in emergency departments throughout the country.

The results of the study conclude that the percentage of radiologist malpractice claims associated with the place of service/type of patient are as follows:

  • Emergency room/emergency department — 46 percent.
  • Inpatients — 17 percent.
  • Outpatients — 38 percent.

Malpractice Claims: ED Radiology Examinations vs. the Medicare Cohort

This study finds that the likelihood of a malpractice claim resulting from an emergency room radiology examination was almost four times higher than the portion of emergency department exams in the Medicare group, which raises the potential that emergency room radiology examinations are more likely to lead to this type of claim than an inpatient or outpatient claim is.

What Causes this Imbalance in Emergency Department Examinations?

The authors of the study believe there are several factors that may be contributing to this lack of balance. One factor was the limitations of Clearview’s database as it only has cases that are presumed to be appropriate for a blind view. Therefore, when malpractice issues relate to procedural complications, communication failure or complaints related to consent, the imaging examination information may not be included in the Cleareview database.

Reasons for an Increase in the Risk for Malpractice Claims in the ER

In the end, the researchers believe their findings offer support to the inference that emergency room examinations pose an increased risk when it comes to malpractice claims for radiologists. One reason for this increased risk could be the numerous specialists that emergency department studies are distributed to. Another issue is the coverage hours and pace that is demanded of emergency radiology staff, which may cause a rise in errors related to diagnosing. Sometimes, radiologists who are working in emergency departments do not have the skills necessary to identify crucial details that only a radiologist with subspecialty training would recognize.

Coverys’ Red Signal Report — An Overview of Diagnose-Related Claims

Robert Hanscom is the vice president of business and analytics at Coverys Insurance. He also wrote the Red Signal Report. While creating this report, Hanscom worked alongside his colleagues to analyze over 10,000 closed claims. As they researched, they focused on identifying any safety vulnerabilities and sizable risk factors for the claims that were filed between the years of 2013 and 2017.

Key Findings of the Red Signal Report

Approximately 15 percent of all the diagnosis-related malpractice claim allegations involved radiologists. An enormous number of these diagnosis-related malpractice claims (80 percent) occurred due to clinical test misinterpretations. And over 80 percent of these cases involved the patient suffering with a serious injury or resulted in the patient’s death. The most common misdiagnosis among the radiology malpractice claims that alleged diagnostic failure was cancer, with the most prevalent being breast, pancreatic, lung and ovarian.

A Section of the Report Recommends Standard Treatment Protocols

One section of the Coverys’ report addresses risk recommendations. Recommendations specifically for the radiology department. These recommendations include the adopting decision support film practices, creating standardized treatment protocols and developing templates to use for reporting. In addition, the team suggests separating their recommendations and incidental findings from the other parts of the imaging report as well as implementing checklists, using clear, concise language to reduce the likelihood of a misunderstanding, while embracing new improvement methods.

According to Hanscom, radiologists play a vital role in delivering an accurate diagnosis. He states that learning from mistakes that were made in the past and identifying the areas that are most prone to mistakes could proactively reduce the number of errors before ever reaching the patient; thus, improving the patient’s overall outcome.