Errors in Anticoagulation Management in the Dermatology Office (Claims Corner CME)
In reviewing closed malpractice claims, The Doctors Company has found an increased risk of claims in patients taking direct acting oral anticoagulants that undergo office-based dermatologic procedures. This case study highlights the factors contributing to the improper management of these patients, including errors in clinical judgment, anticoagulant management, and communication.
Anesthesia Care Preventing Dental Injury
Dental injury claims continue to make up almost a quarter of all anesthesiology claims (22 percent) with over 30 percent of tooth damage claims resulting in indemnity payments to the plaintiff. Due to the frequent occurrence of dental injury claims, anesthesia professionals must be aware of dental injury causes, preventive measures, and steps to take if injury occurs.
Prevention of Medical Errors (2023–2025 Edition)
Few medical errors are attributed to faulty medical judgment. More commonly, they are attributed to system failures inherent in healthcare delivery. By drawing on our professional liability closed claims data, we have identified common performance and diagnostic errors. We analyzed loss prevention measures in tandem with the elements necessary to conduct a credible and thorough root cause analysis to reduce system failures, respond to sentinel events, prevent medical errors, and improve patient safety. The purpose of this program is to provide clinicians with the most current information regarding the prevention of common performance and diagnostic errors.
Prevention of Medical Errors – Florida (2023–2025 Edition)
This activity is specific to Florida statutes and reflects regulations effective February 2022. Few medical errors are attributed to faulty medical judgment. More commonly, they are attributed to system failures inherent in healthcare delivery. By drawing on our professional liability closed claims data, we have identified common performance and diagnostic errors that reflect on the most common issues identified by Florida: wrong site surgery, surgery complications, cancer, gastroenterology conditions, cardiology issues, neurological issues, and adverse drug events, which will serve as the focal point of this patient safety and risk management course.
Oct 20, 2022
Job Shadowing: Observers, Volunteers, and Students in Clinical Settings
Create guidelines to prevent practice risks, eliminate patient harm, and protect patient privacy.
Oct 18, 2022
Moderate or Conscious Sedation in the Office Setting
Prevent patient injury when providing moderate sedation in the office by incorporating these patient safety and practice improvement strategies.
Oct 12, 2022
Suicide and Crisis Lifeline: Call or Text 988
The National Suicide Prevention Lifeline is now 988, an easy-to-remember number for 24/7 crisis care.
Reducing the Risk of a Malpractice Claim
This enduring program is designed to assist physicians, dentists, and advanced practice clinicians, improve patient safety by providing information on how to implement a root cause analysis (RCA2) when a near-miss, or injury has been identified. Real cases serve as examples of how sustainable change can minimize human and environmental factors while decreasing system failures and reducing the risk of a malpractice claim.
Sep 22, 2022
Mental Health Providers: Balancing Privacy With Public Welfare
Since spring 2020, patients have reported ideation of harm with increasing frequency. These encounters create a moral dilemma for mental health providers, who must maintain provider-patient privilege while adhering to legal reporting obligations for protecting the public welfare.
Test Tracking and Referrals: Strategies for Advanced Practice Clinicians
Tracking of tests and consults is critically important in preventing diagnostic errors and preventing patient harm. The risk factors triggering an alleged malpractice claim were primarily related to the breakdown in clinical systems for test result management. Failures of systems often prevent providers from making timely and accurate diagnoses. Testing failures included test performance issues, misinterpretation of studies, receipt, and transmittal problems. Follow-up failures included lack of physician follow-up with the patient, referral management, inadequate provider to provider communication and patient noncompliance.
Sep 16, 2022
Reduce Patient Safety Risks With Vaccinations, Including COVID-19
Vaccine administration is usually regarded as a simple office procedure, often performed without the direct supervision of the physician or a licensed professional. Although vaccinations are a routine procedure, physicians and staff should remain vigilant about patient safety considerations. Whether you’re seeing children for COVID-19 vaccinations or adults for travel abroad or general disease prevention, take time now to assess the vaccine administration protocol in your practice.
Sep 15, 2022
Resources for Advanced Practice Clinicians
We recognize the important role that advanced practice clinicians play in reducing risks and improving patient outcomes. You can count on The Doctors Company to support you with comprehensive expert resources.
Sep 15, 2022
Advanced Practice Clinicians: A Preventive Action and Loss Reduction Guide
Depending on the state, an APC may be permitted to practice autonomously, as part of a collaborative agreement, or under the supervision of a physician. Regardless of an APC’s practice status or employment arrangement, however, all individuals can be held liable for their own acts of negligence. Our preventive action and loss reduction guide can help APCs in every practice environment.
Delayed Diagnosis of Malignancy: Case Review for Advanced Practice Clinicians
In reviewing closed malpractice claims, The Doctors Company identified delayed diagnosis of a malignancy as a reoccurring problem. The following highlights the importance of recognizing a spinal abnormality and recommending further follow up of a lesion seen on imaging. Contributing factors include misinterpretation of radiologic studies, narrow diagnostic focus, lack of communication, and failure to establish a differential diagnosis.
Medication Management: Strategies for Advanced Practice Clinicians
Medication management is by far the area providers can make the most impact within the professional practice arena. Data from closed claims shows that medication management is a risky area, most importantly the monitoring of medications. Monitoring and management begin when the patient receives the medication until the patient is no longer on the medication. An effective medication management process is essential for safe patient care. Having current patient medication information will assist with subsequent prescribing and a plan of care.
Preventing Dictation Errors for Advanced Practice Clinicians
Emergency medicine providers are increasingly using voice recognition programs, such as Dragon Direct Voice Recognition Program, to document encounters. In reviewing closed malpractice claims, The Doctors Company identified dictation errors as a significant patient safety risk factor. The following case highlights the importance of timely recognition of dictation errors to ensure accuracy of the permanent electronic health record (EHR). This is particularly important when using a voice recognition program to document encounters in the busy emergency department. In this case, the voice recognition system was Dragon Direct Voice Recognition Program.
Delayed Diagnosis of Stroke: Case Review for Advanced Practice Clinicians
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke. Factors contributing to delay diagnosis and treatment included failure to recognize the window (“last known well time”) for tissue plasminogen activator-clot buster (tPA) failure to order a stat MRI and neurology consult, failed communication among providers regarding changes of recurring symptoms of ischemic stroke, failure to appreciate new signs and symptoms of a stroke, and poor or inconsistent documentation. The National Academy of Medicine (NAM) has identified the top three causes of serious harm from diagnostic failure. Number one is ischemic stroke.
Jul 21, 2022
Effective Obstetrical Team Communication
Effective communication requires a team effort for the exchange of concise and relevant information.
Managing Patient Information: Strategies for Advanced Practice Clinicians
This program covers the patient information system, specifically documentation of patient information in the medical record. Many times, insufficient documentation results in the provider not being able to find information needed to guide clinical decision-making. Adequate documentation will enhance patient care by ensuring that patients receive the care necessary and may prevent a mis- or delayed diagnosis.
Diversity, Equity, and Inclusion in Healthcare
Diversity, equity, and inclusion of all patients can lead to better health outcomes in the community in which we work. Creating a culture of inclusion and understanding our own biases, will help us improve patient care. It is important to understand how we are the same and how we are different in language, education, race, ethnicity, gender, gender identify, sexual orientation, age, social class, physical ability, religion, political beliefs, and morals. Ensuring equity creates fair and just opportunities to receive and benefit from healthcare. In addition, deliberately including all peoples creates a welcoming and respectful environment for our patients.
Providers may not be aware of how diversity, equity, and inclusion problems can hinder their care and relationships with patients. Some states are requiring all clinical professionals to have continuing education on cultural and linguistic competency and implicit bias.
Preventing Diagnostic Error in Primary Care: Strategies for Advanced Practice Clinicians
Diagnostic errors occur often in primary care settings and can impact over 12 million outpatients annually. This is a top patient safety concern and a global burden among advanced practice clinicians (APCs). Significant patient harm can occur due to treatment delay, testing, or misdiagnosis. This course is an opportunity to promote awareness and visibility by identifying where these errors occur most often in the diagnostic process of care framework. Examples of some best practices for the diagnostic process involves a timely and accurate diagnosis, patient engagement, effective system processes, active follow up, and communication. The information in this course will focus heavily on prevention strategies related to the primary care setting.
Cervical Cancer Claims: A Review for Advanced Practice Clinicians
Cervical cancer medical negligence claims are reviewed over a 10-year period to identify the major case types in which the advanced practice clinician (APC) is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense provider experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
Breast Cancer Claims: A Review for Advanced Practice Clinicians
Breast cancer medical negligence claims are reviewed over a 10-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
Hidden Liability Risks Identified by Medical Office Reviews: Risky Practices for Advanced Practice Clinicians
Office practice assessments by TDC Group's patient safety risk managers uncover hidden liability risks, often exposing areas where patients can “fall through the cracks” and leave the practice vulnerable to a malpractice claim. Our Practice Risk INSIGHT, an assessment tool customized by specialty, zeros in on problematic areas. The assessments have been completed across a range of practice environments around the country—from small offices to practices that are part of large integrated delivery systems. In this course, we analyze the results of the Practice Risk INSIGHT assessments, highlight problem-prone areas, and offer strategies to minimize liability for advanced practice clinicians (APCs).
The Advanced Practice Clinician–Patient Relationship: When Does it Begin and When Does it End?
This enduring program will assist the participant in understanding the principles which form the establishment of an advanced practice clinician (APC)–patient relationship, as well as the concerns which may result in the need for the APC to consider terminating the APC-patient relationship. Additionally, the concepts of providing patient-centered care will be presented for the learner’s consideration.
Learning from Pain Management Closed Claim Analysis for Advanced Practice Clinicians
TDC Group has published an analysis of lawsuits and claims filed against pain management advanced practice clinicians (APC). This study completed in 2020 provides quantitative and qualitative information that an APC who practices pain management, including interventional approaches to treatment would find useful in mitigating the risks of unintended outcomes or harms. This study breaks down where most patient injuries occur, what those injuries are, and the lessons learned from those claims.
Administrative and Regulatory Actions: Protecting Your Practice
Healthcare practitioners, including physicians, dentists, and advanced practice clinicians, need to understand the roles of their professional licensing board and state and federal agencies to protect the public.
An Introduction to Enhancing Patient Relations and Reducing Risks for Advanced Practice Clinicians
This enduring program is designed to assist advanced practice clinicians (APCs) with improvements in patient interactions by looking at how incorporating hospitality as a focus makes a difference. It has been developed to improve multiple facets of patient interaction.
Clinical Presentations for Advanced Practice Clinicians: Failure to Diagnose Myocardial Infarctions
In reviewing closed malpractice claims, TDC Group identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
When Personal Relationships Interfere with the Standard of Care for Advanced Practice Clinicians
The Doctors Company rigorously analyzed 988 claims* against internal medicine physicians that closed from 2009–2018. Regardless of the outcome, all cases that closed from 2009–2018 were included in this analysis—an approach that helps better understand what motivates patients to pursue claims and gain a broader overview of the system failures and processes that result in patient harm.
May 31, 2022
The Role of the Medical Assistant in Your Office Practice
A medical assistant (MA) can be a valuable addition to an office practice, but MAs should not perform tasks outside their scope of practice.
Video May 04, 2022
Why Will Advanced Practice Clinicians Become the Primary Care Providers for Many Americans?
Laura Kline, MBA, CPCU, Senior Vice President of Business Development for The Doctors Company, discusses the expanding role of advanced practice clinicians and why they will become the primary care providers over the next decade.
Video May 04, 2022
The Integration of Advanced Practice Clinicians into Healthcare Systems Will Improve Access to Care
Laura Kline, MBA, CPCU, Senior Vice President of Business Development for The Doctors Company, explains how the integration of advanced practice clinicians into healthcare systems can improve access to care, particularly for underserved populations.
HIPAA Fundamentals 2022–2023 Edition
This on-demand program provides an orientation to the basic requirements of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA gives patients many rights with respect to their health information. This program provides details on the HIPAA Privacy, Security, and Breach Notification Rules, such as the type of information that is protected, who must comply with the rules, and how patient information can be used and disclosed. This on-demand program includes many resources useful to staff training.
Apr 01, 2022
Delay in Diagnosing Breast Cancer: A Case Summary and Tips to Reduce Risk
A delay in diagnosing breast cancer may result when a patient doesn’t follow through with diagnostic recommendations.
Feb 23, 2022
Pediatrics: Addressing Social Determinants of Health and Adverse Childhood Experiences
The role of the pediatrician, which encompasses the management of a child’s physical, behavioral, and mental health, is critical in preventing and mitigating childhood adversity and trauma.
Sep 29, 2021
Getting Sued for Breast Cancer Malpractice
Our closed claims data reveal that suits involving breast cancer are the most common type of cancer-related claim. This article lists the issues that most often lead to claims.
Sep 23, 2021
The Malpractice Experience of Obstetricians with Shoulder Dystocia: Preparation May Mitigate Risks With This Unpredictable Event
Shoulder dystocia (SD) is a rare complication of vaginal delivery. The purpose of this study was to better understand factors that may contribute to medical malpractice claims with SD and to offer recommendations to practicing obstetricians regarding the management of SD.
Patient Relations: Spotlight on Challenging Situations
The Doctors Company’s dedicated patient safety risk managers deliver a wide range of expert services and resources to our members—including personal telephone consultations to help guide members through challenging situations. A recent review of our call data shows that “patient relations” and “patient termination” consistently appear as the top reasons that members request assistance. The following strategies can help prevent challenging patient situations and provide guidance if one occurs.
Jul 16, 2021
Obstetrics and Gynecology: Frequently Asked Patient Safety Questions
Our experts answer questions about topics in obstetrics and gynecology, including cesarean delivery on maternal request and screening mammograms.
Jun 29, 2021
Pediatrics: Consider Car Window Hammers for Your Office Emergency Response Kit
Seconds count if an infant, toddler, or young child is accidentally locked inside a hot vehicle. A car window hammer can be a lifesaving tool to include in an emergency response cart or kit.
May 18, 2021
Patient Safety Tips for Obstetrics and Gynecology
These strategies can help you keep your patients safe and reduce potential liability. The tips highlighted here include tracking test results, documenting prenatal records, discussing birth plans, and managing noncompliant patients.
Mar 29, 2021
Is Your Patient a Victim of Human Trafficking?
Although trafficking victims rarely find opportunities to interact with others, a visit to a physician or dental practice may provide an opportunity for a victim to receive help. Learn to recognize the signs of human trafficking and know what steps to take.
Mar 24, 2021
Patient Selection for Elective Cosmetic Procedures
The patient selection process is a valuable tool that can help you reduce risks when you assess prospective patients for elective cosmetic procedures.
TeamSTEPPS® Teamwork Training in the Office Practice
This course provides an overview of the evidence-based TeamSTEPPS® concepts, tools, and strategies based on the four areas of 1) leadership, 2) mutual support, 3) situation monitoring, and 4) communication. TeamSTEPPS training provides teachable/learnable skills that improve
communication and teamwork among healthcare professionals in both acute care and ambulatory care environments.
Jan 29, 2021
Pain Management Closed Claims Study
The Doctors Company reviewed medical malpractice claims that closed between 2008 and 2018 and involved pain management physicians as the primary specialty responsible in the claim. That criteria identified 273 claims and lawsuits.
Jan 20, 2021
Implicit Bias Against Obesity: An Opportunity to Improve Patient Safety
Many patients with obesity delay seeking medical care because of previous negative experiences with healthcare providers.
HIPAA for Managers: The High-Level View
The program explores and defines HIPAA policies and procedures, business associate agreements, security assessment and analysis, training requirements, HIPAA compliance requirements, breach events, and informed consent.
Dec 16, 2020
Nonadherent and Noncompliant Patients: Overcoming Barriers
Nonadherent or noncompliant patient conduct—whether intentional or unintentional—can affect clinical outcomes. Our strategies can help you uncover and address compliance barriers.
It's the Little Things: An Introduction to Enhancing Patient Relations and Reducing Risks
It's the Little Things is designed to assist medical practices with improvements in patient interactions by looking at how incorporating hospitality as a focus makes a difference. It has been developed to improve multiple facets of patient interaction.
Dec 08, 2020
Suicide Prevention: Primary Care Is a Crucial Setting for Identifying Risk
At any given time, some of your patients are having thoughts of suicide. Effective suicide prevention requires a comprehensive approach.
Sep 02, 2020
Remote Patient Monitoring
The adoption of telehealth strategies has soared, including the use of remote devices that collect data and send it to the patient’s doctor in real time. Although remote monitoring has advantages for both providers and patients, it entails cyber liability risks.
Aug 25, 2020
Distracting Devices in Healthcare: Malpractice Implications
Digital distraction in healthcare is a threat to patient safety and physician well-being. Personal electronic devices can create a digital distraction so engaging that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients.
Making an Informed Consent an Informed Choice: Training for Healthcare Professionals
This activity, designed for doctors, nurses, and other providers, examines problems with the process of healthcare informed consent. It describes the principles of informed consent and highlights the benefits gained from a good informed consent process.
Jul 07, 2020
Weekend Call Presents Unique Challenges with Surrogate Birth
Communication among healthcare providers, patients, and adoptive parents is critical.
Jun 15, 2020
Overview of Obesity-Related Malpractice Claims
The Doctors Company continues to see an increase in lawsuits involving patients with obesity.
May 13, 2020
Did Emergency Department Provider Fatigue Contribute to This Patient’s Death?
Provider fatigue and the rush to get things done when staffing levels are inadequate can lead to mistakes and poor outcomes for patients.
Apr 29, 2020
Patient Safety in Anesthesia Care
Anesthesiologists can reduce potential liability by taking risk management steps, such as obtaining separate informed consent for anesthesia care.
Apr 16, 2020
Shoulder Dystocia Documentation: Implementing a Protocol
Shoulder dystocia claims have traditionally been among the most problematic to defend.
Mar 23, 2020
Preventing Falls in Patients with Morbid Obesity: Case Study
It is imperative that hospitals provide employees with training and guidance that specifically addresses caring for morbidly obese patients.
Feb 11, 2020
Laboratory and Diagnostic Test Tracking in Ambulatory Practice
Inadequate clinical laboratory and diagnostic test tracking is a top factor leading to patient injury.
Jan 17, 2020
Medical Malpractice and Preparticipation Sports Physicals
Physicians should be aware of liability risks associated with preparticipation sports physicals.
Dec 12, 2019
Making Further Advancements in Anesthesia Care Safety
We analyzed 459 claims for new trends in anesthesia care.
The Doctor’s Advocate
Sep 05, 2019
Advanced Practice Provider Closed Claims: What Can We Learn?
Top allegations in our claims analysis involving advanced practice providers centered on diagnosis.
The Doctor’s Advocate
Aug 27, 2019
Electronic Health Records Continue to Lead to Medical Malpractice Suits
We analyzed 216 medical malpractice claims that closed from 2010 to 2018 in which EHRs contributed to patient injury. The pace of these claims grew, from a low of seven cases in 2010 to an average of 22.5 cases per year in 2017 and 2018. As EHRs approach near-universal adoption, they may become a more prevalent source of patient safety risk.
Jul 10, 2019
Delay in Treatment of Fetal Distress
We studied claims alleging delay in treatment of fetal distress in the hope of reducing neonatal injuries.
Mar 20, 2019
Study of Malpractice Claims Involving Children
The Doctors Company analyzed 1,215 claims filed on behalf of pediatric patients that closed from 2008 through 2017. The study is based on the claims filed against physicians in 52 specialties and subspecialties and includes an overview of the most common types of claims, expert insights into the specific elements that led to patient injury, and risk mitigation strategies.
Jan 15, 2019
Maternal Injury and Death Closed Claims Study
Each year, 700 women die from complications related to childbirth in the U.S. This analysis of closed malpractice claims involving maternal injury and death identifies potential sources of patient injury and provides tools for enhancing safety in ob/gyn.
Nov 16, 2018
Opioid Addiction in Pregnant Women and Moms: How to Make a Difference
Treating pregnant women and mothers with opioid addiction calls for a well-informed approach to patient safety.
Mar 26, 2018
Nurse Practitioner Closed Claims: Risk Mitigation Strategies
Strategies to help nurse practitioners and physicians prevent patient injuries.
The Doctor’s Advocate
Video Mar 26, 2018
Nurse Practitioners and the Changing Delivery of Primary Care
Increasingly, the growing need for primary care services will be met with nurse practitioners. The Doctors Company studied nurse practitioner medical malpractice claims over a six-year period and compared them to claims against primary care physicians (family medicine and internal medicine) to identify risk management issues that may be unique to nurse practitioners.
Mar 09, 2018
Nurse Practitioner Closed Claims Study: Top Risks in the Changing Delivery of Primary Care
Our study of nurse practitioner medical malpractice claims, compared against family medicine and internal medicine claims, identifies the top patient safety risks that may lead to adverse events.
Aug 28, 2017
Obstetrical Closed Claims: What Can We Learn?
These lessons learned from our analysis of closed obstetrical claims are part of our CME article series.
The Doctor’s Advocate