Insurer’s Hospital Claims Study Corroborates High Death Risk from Medical Errors

Death claims are the most common hospital liability claims, according to an insurance company study released after researchers at Johns Hopkins University School of Medicine reported that medical errors are the third leading cause of deaths in the United States.

The CNA Hospital Professional Liability Claim Report 2015: Stepping Up to Quality Healthcare and Patient Safety identifies patient death as the most common injury in closed claims over a 10-year period, January, 2005 through December, 2014.

According to the Johns Hopkins researchers, medical errors in the U.S. account for more than 250,000 deaths per year, which makes them the third leading cause of death in the country, after cancer and respiratory disease.

The Johns Hopkins researchers said that most medical errors rare due to poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.

The report by the Chicag0-based commercial insurer CNA found that death is the most common claim from medical errors in hospitals, comprising 34.3 percent of the closed claims.

While the average hospital injury claim paid is $251,000, the average total paid in a hospital death claim is $321,000, which ranks second in total average claim payment. Claims for neurological or brain injuries average higher, at $551,000, and account for about 11 percent of all injuries.

Overall improper care is the allegation most frequently related to patient death, followed by allegations related to diagnosis or medication error.

CNA found that death is the most frequent injury outcome for:

• Emergency department-related claims (47.7 percent of 107 closed claims)
• Medication error-related claims (48.1 percent of 52 closed claims)
• Medicine patient and ambulatory care-related claims (50.7 percent of 138 closed claims)
• Pressure ulcers-related claims (41.9 percent of 31 closed claims)

According to the CNA researchers, patient hand-offs in an emergency department represent a significant vulnerability in the hospital setting. Frequently, healthcare professionals inadvertently fail to convey critical patient information to one another.

“Communication among healthcare providers is critical in any situation, but particularly in an emergency department,” said Joyce Benton, assistant vice president, Risk Control, CNA. “Research has shown that ineffective or inadequate communication is a major factor in medical errors and near-misses, especially during handoffs and other transitions in care.”

The Hospital Professional Liability Claim Report recommendations related to improving communication include:

• Train staff to use structured formats for exchanging information, such as the “Situation, Background, Assessment and Recommendation” method.
• Encourage use of the chain of command, and prohibit any retaliation on the part of colleagues or supervisors.
• Develop an effective procedure to manage diagnostic test result reporting and follow up.

The Johns Hopkins team says that how the U.S. collects national health statistics fails to allow for classifying medical errors separately on death certificates. The researchers are advocating for updated criteria for classifying deaths on death certificates.

Topics Carriers USA Claims Medical Professional Liability