Blog | Wednesday, April 24, 2013

QD: News Every Day--Diagnostic errors the most common, costly of malpractice claims

Diagnostic errors were the most common, costly and dangerous of medical mistakes among malpractice claims, and not surgical and OB/GYN claims, a study found.

Researchers analyzed more than 350,000 paid, closed malpractice claims from the National Practitioner Data Bank from 1986 to 2010. Results appeared online at BMJ Quality & Safety.

Diagnostic errors were the most common type (28.6%) and accounted for the highest proportion of total payments (35.2%). The most frequent types were failure to diagnose (54.2%), delay in diagnosis (19.9%), and wrong diagnosis (9.9%).

Following diagnostic errors, malpractice claims were related to treatment (27.2%), surgery (24.2%), obstetrics (6.5%), medication (5.3%), aesthesia (3%), monitoring (2%) and other miscellaneous (2%).

The most frequent outcomes were death, significant permanent injury, major permanent injury and minor permanent injury. Diagnostic errors more often resulted in death than other allegation groups (40.9% vs 23.9%, P less than 0.001) and were the leading cause of claims-associated death and disability. There were more outpatients claims than inpatient ones (68.8% vs 31.2%, P less than 0.001), but inpatient diagnostic errors were more likely to be fatal (48.4% vs 36.9%, P less than 0.001).

The inflation-adjusted, 25-year sum of diagnosis-related payments was $38.8 billion (mean per-claim payout $386,849; median $213,250; IQR $74,545 to $484,500). Per-claim payments were higher for permanent, serious morbidity that resulted in a need for quadriplegic, brain damage, lifelong care (4.5%; mean $808,591; median $564,300),for major morbidity (13.3%; mean $568,599; median $355,350), or for significant morbidity (16.9%; mean $419,711; median $269,255) than for those where the outcome was death (40.9%; mean $390,186; median $251,745).

Researchers noted that diagnostic errors directly increase health care costs through the adverse outcomes, inappropriate tests and treatments, and malpractice claims. Health care costs are indirectly increased through rising medical liability premiums, defensive medicine and the loss of physicians who no longer practice because of insurance premiums.

"Theoretical arguments to the contrary, notwithstanding, empirically, the malpractice system in the USA appears to increase costs while decreasing quality and safety, and threatening access," they wrote.