How to leverage data to mitigate medical malpractice risk

Dana Siegal, Coverys

Editor's note: This interview has been lightly edited for brevity and clarity.

Minimizing medical malpractice and the resulting claims has always been important for healthcare providers. As data analytics and AI continue to progress the industry’s ability to self-assess vulnerabilities, technology has becoming increasingly intertwined with the goal of reducing diagnostic errors and improving patient outcomes. Physicians Practice sat down with Dana Siegal—Vice President of Risk Management and Analytics at Coverys—to discuss the utilization of data in identifying high-risk areas for malpractice and strategies healthcare providers can implement to mitigate these risks.

Physicians Practice: What is your role at Coverys?

Siegal: As the Vice President of Risk Management at Coverys, I oversee a national team of risk consultants with a clinical focus. Our primary goal is to help our insured manage their medical malpractice risks. My background is in emergency medicine, and I've been involved in quality and risk management for nearly 20 years. Our work focuses on understanding where vulnerabilities in the care delivery system are and learning from past claims to improve patient care.

At Coverys, we believe in using data-driven insights to enhance patient safety and reduce risks. My role involves not only leading our risk management team but also working closely with our clients to develop tailored strategies that address their specific challenges. By analyzing claims data and identifying patterns, we can proactively address potential issues before they escalate into larger problems.

Physicians Practice: How does Coverys utilize data to identify the highest risk areas for medical malpractice claims?

Siegal: We focus on the clinical journey of healthcare. Our claims data and reviews help us identify events and claims at an individual level, but we also look at the broader clinical stories. We analyze what led to unexpected outcomes and the root causes. For instance, in surgical events, we might look at technical issues, decision-making processes, or post-op care. Understanding these vulnerabilities helps us improve the system and prevent future claims. By taking a holistic approach to data analysis, we can pinpoint specific areas where errors are more likely to occur. This involves examining various factors, such as the types of procedures being performed, the complexity of patient cases, and the communication protocols in place. By identifying these high-risk areas, we can implement targeted interventions and training programs to mitigate risks and enhance overall patient safety.

Physicians Practice: How does the current healthcare environment impact the likelihood of malpractice claims?

Siegal: The current healthcare environment, particularly post-pandemic, has increased the complexity of care delivery. Providers are facing staffing shortages, burnout, and increased patient volumes, all of which can contribute to mistakes. Telehealth has also introduced new challenges in maintaining continuity of care and ensuring thorough documentation. These factors create additional pressures that can lead to errors if not managed effectively.

Healthcare providers are navigating an unprecedented landscape where the demand for services often outstrips the available resources. This situation can lead to rushed consultations, incomplete documentation, and ultimately, a higher risk of malpractice claims. It's crucial for healthcare organizations to recognize these challenges and invest in supportive measures, such as staff well-being programs and enhanced telehealth protocols, to ensure that patient care remains safe and effective.

Physicians Practice: You've identified diagnostic errors in the clinic setting as a major area of claims. Can you elaborate on the common types of diagnostic errors and their contributing factors?

Siegal: In the ambulatory setting, diagnostic errors are the most common cause of malpractice claims, particularly in oncology—breast cancer, lung cancer, and skin cancer are frequent areas. These errors are often due to the disjointed nature of ambulatory care, where communication failures and incomplete patient histories can lead to missed diagnoses. Patient engagement is also critical; ensuring patients understand the importance of tests and follow-ups can prevent errors.

Additionally, diagnostic errors can stem from cognitive biases, such as anchoring or confirmation bias, where providers might focus on an initial diagnosis and overlook alternative explanations. Inadequate follow-up on test results and referrals further exacerbates the problem. By addressing these contributing factors through continuous education, improved communication protocols, and robust follow-up systems, healthcare providers can reduce the incidence of diagnostic errors.

Physicians Practice: How do follow-up and coordination of care impact diagnostic accuracy and risk management?

Siegal: Follow-up and coordination of care are essential in mitigating diagnostic errors. A lack of proper follow-up on test results or specialist referrals can lead to significant delays in diagnosis and treatment. Ensuring that there are systems in place for tracking and managing patient follow-ups can greatly reduce the risk of missed or delayed diagnoses. Providers need to work collaboratively and maintain open lines of communication to ensure patients receive timely and appropriate care. Effective coordination of care involves not only tracking patient appointments and test results but also ensuring that all relevant information is communicated between providers. This requires a team-based approach where each member understands their role in the patient's care journey. Implementing electronic health records (EHR) systems that facilitate seamless information sharing can help bridge communication gaps and enhance overall patient safety.

Physicians Practice: Can you provide examples of how communication failures contribute to diagnostic errors?

Siegal: Absolutely. One example is the communication between primary care providers and specialists. If a primary care provider refers a patient to a urologist without adequate information, the specialist might not understand the full context, leading to missed diagnoses. Another example is the failure to relay critical information from front desk staff to providers. Every member of the healthcare team plays a crucial role in ensuring accurate diagnoses, and communication breakdowns can significantly impact patient outcomes.

In another scenario, imagine a patient presenting to the emergency department with nonspecific symptoms. If the initial triage notes are not thoroughly communicated to the attending physician, critical details might be overlooked, resulting in a misdiagnosis. These examples highlight the importance of clear, concise, and complete communication within the healthcare team to avoid errors that can have serious consequences for patient safety.

Physicians Practice: How can the culture within a healthcare practice influence the likelihood or prevention of diagnostic errors?

Siegal: A strong culture of patient safety is essential. Organizations should have clear policies and procedures for communication and documentation. Regular assessment of these policies is critical to ensure they are followed. Encouraging a culture of reporting and learning from events can help identify and address vulnerabilities. Psychological safety is also important; staff should feel comfortable speaking up about potential issues without fear of retribution. Cultivating a culture that prioritizes patient safety involves continuous education and training on best practices for communication and documentation. Leadership plays a crucial role in setting the tone for a safe and open environment where staff can report errors or near misses without fear of punishment. By fostering such a culture, healthcare organizations can proactively identify and address potential risks, thereby reducing the likelihood of diagnostic errors.

Physicians Practice: Can you speak to the role of documentation in preventing or contributing to diagnostic errors?

Siegal: Documentation is a critical aspect of communication. For example, a provider who documents the next steps for a patient's treatment can ensure continuity of care, even if another provider takes over. Inadequate documentation can lead to significant gaps, such as in the case of a patient with a complex medical history that isn't fully communicated. The use of patient portals for communication also requires careful attention to ensure that all relevant information is documented and addressed promptly. Thorough documentation not only supports clinical decision-making but also serves as a legal record that can protect providers in the event of a malpractice claim. Detailed and accurate documentation provides a clear account of the patient's history, the care provided, and the rationale behind clinical decisions. This transparency is crucial in defending against allegations of negligence and demonstrating that appropriate care was delivered.

Physicians Practice: What are some best practices for improving communication and documentation to prevent diagnostic errors?

Siegal: Best practices include ensuring all providers are aware of and follow established communication protocols, such as sending notes ahead of patient consultations and promptly updating patient records. Regular training and reminders about the importance of thorough documentation can also help. Using event management systems to capture and analyze incidents can provide valuable insights for ongoing improvement.

Implementing standardized communication tools, such as SBAR [Situation, Background, Assessment, Recommendation], can enhance the clarity and consistency of information exchange among healthcare providers. Additionally, leveraging technology, like secure messaging and EHRs, can facilitate real-time updates and access to patient information. Continuous education on the importance of documentation and regular audits to ensure compliance with protocols are also essential in maintaining high standards of patient care.