Jun 17, 2022
RCA2: Panel Report on Improving Root Cause Analyses and Actions to Prevent Harm
James P. Bagian, MD, PE, member of The Doctors Company Board of Governors, co-chaired a panel with the National Patient Safety Foundation to improve how we can learn from adverse events and unsafe conditions and take action to prevent their occurrence in the future.
Safe Opioid Prescribing for Physicians and Dentists
Opioids play an important role in pain management—both in the acute and the chronic setting, but a variety of causes have contributed to an opioid-related epidemic leading to addiction and death. There has also been substantial misuse of opioids by prescription and by diversion.
Clinical Presentations Cause Delays: Failure to Diagnose Myocardial Infarction
In reviewing closed malpractice claims, The Doctors Company 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.
Delayed Diagnosis of Stroke
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.
Cervical Cancer Claims: A Review in Gynecology
Cervical cancer medical negligence claims are reviewed over a ten-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.
Alzheimer's – 4 Addressing Patients' and Families' Needs through the Disease Stages of Dementia
This activity includes seven video lectures and is the fourth in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This fourth course covers life planning through disease stages, assessing and assisting caregivers, improving communications, utilizing community resources, and end of life decision-making. These sensitive conversations with patients. The course finishes with a focus on dementia resources, effective communication strategies, and understanding when it is time to make a referral to a specialist.
Alzheimer's – 2 Evaluation and Diagnosis of Alzheimer’s Disease and Related Dementias
This activity includes eight video lectures and is the second in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This second course introduces the Alzheimer’s project evaluation algorithm and evaluation instruments and focuses on differential diagnoses. Finally, the course discusses how to prepare and engage in a sensitive dementia diagnosis disclosure with patients and caregivers.
Alzheimer's – 3 Addressing and Managing Behavioral and Environmental Symptoms of Dementia
This activity includes eight video lectures and is the third in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This third course focuses on using the DICE method to assess behavioral symptoms of dementia and create and evaluation treatment plans. This course also covers the careful use of medication during disease management as wells as common behavioral issues with dementia patients including tools for management of these behaviors.
Alzheimer's – 1 Screening for Dementia Among Adults with Cognitive Decline
This activity includes eight video lectures and is the first in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This first course focuses on introducing the Alzheimer’s Project and highlighting the increasingly important role of primary care providers in dementia care. This course also introduces the Alzheimer’s Project cognitive impairment screening algorithm and screening instruments and covers addressing reversible conditions that may present similar symptoms to cognitive impairment.
Prevention of Dental Errors for Dental Practices
Few dental errors are attributed to faulty 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:
wrong-site surgery, improper performance of dental procedure, wrong or unnecessary treatment or procedure, retention of foreign body during treatment, and diagnosis related. We analyzed loss prevention measures in tandem with the elements necessary to conduct a credible and thorough root cause analysis (RCA) to reduce system failures, respond to sentinel events, prevent dental errors, and improve patient safety. The purpose of this continuing dental education activity is to provide dentists with the most current information regarding the prevention of common performance and diagnostic errors.
The course covers:
• Identification of the most common quality-of-care violations.
• Illustrative case studies detailing prevalent diagnostic and performance errors.
• The necessary elements of an RCA.
• Safety systems in healthcare organizations.
• Risk management measures designed to prevent dental errors and increase patient safety.
Prevention of Dental Errors
for Florida Dental Practices
The purpose of this continuing dental education activity is to provide
dentists with the most current information regarding the prevention of
common performance and diagnostic errors. The course covers:
• Identification of the most common quality-of-care violations.
• Illustrative case studies detailing prevalent diagnostic and
• The necessary elements of an RCA.
• Safety systems in healthcare organizations.
• Risk management measures designed to prevent dental errors and
increase patient safety.
This course is specific to Florida statutes and reflects regulations
effective in February 2018 for dentists licensed by the Florida Board of
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.
Aducanumab for Treatment of Alzheimer's Disease – Controversy and Appropriate Communications
Panel discussion among neurologists and geriatric psychiatrists to clarify controversial issues surrounding the FDA’s recent approval of Aducanumab for treatment of Alzheimer's disease, and appropriate messaging to patients and family members. Following their presentations, the panel experts will conduct a question-and-answer session.
Pathologists and Surgeons Can Collaborate to Reduce Diagnostic Error
The Doctors Company has updated the claims filed against pathologists between the years 2015 and 2020. The information provides quantitative and qualitative data that a pathologist and surgeon would find meaningful in reducing diagnostic error. This program provides a breakdown of where patient injuries occur involving pathologists and surgeons and how collaboration between the two disciplines can improve patient outcomes.
Patient Safety in Spine Surgery
Spine surgery requires a series of best practice patient safety
interventions to reduce the frequency and severity of patient harm while
giving the care team the resources to mitigate such harm. Evidence-based clinical methods, pathways, and tools coupled with an evolving culture of patient safety through effective communication, teams, and teamwork has shown to reduce patient harm exponentially. Patient and clinical team experiences are enhanced while ensuring a learning culture is built that approaches surgery from both a technical and nontechnical approach alike.
The Need for Close Monitoring in Hyponatremia: Osmotic Demyelination Syndrome
In reviewing closed malpractice claims, The Doctors Company identified mismanagement of sodium levels during correction of severe hyponatremia as a serious problem that can result in catastrophic permanent neurological injury due to osmotic demyelination syndrome (also known as central pontine myelinolysis). This article highlights the importance of close monitoring of sodium levels during correction of severe hyponatremia, with a slow and controlled pace of sodium correction. Contributing factors discussed include clinical judgment with regard to rate of rise of sodium levels, patient monitoring, choice of practice setting, and communication between providers, especially at points of transition in care.
Risky Practices: Hidden Liabilities Identified by Medical Office Assessments
Office practice assessments by The Doctors Company'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.
Jun 17, 2021
Deferred, Delayed, Disrupted: Mitigating Risks from Care During COVID-19
The pandemic has disrupted healthcare so thoroughly that in some sense, COVID-19 has affected all of healthcare. The effect on care has been stunning in magnitude. By mid-2020, more than 40 percent of U.S. adults had delayed medical care or avoided it entirely, including care for urgent and emergent complaints.
Jun 09, 2021
Prevent, Communicate, Document: Medical Malpractice Data Help Us Manage Risk
Medical malpractice data provide a rich source of information, offering insights into high-risk specialties, medical conditions, and procedures that result in claims.
The Doctor’s Advocate
Breast Cancer Claims – A Review in Gynecology
Breast cancer medical negligence claims are reviewed over a ten-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.
Pain Management - A Closed Claim Analysis Looking at Risks and Lessons Learned
For the first time, The Doctors Company has published an analysis of lawsuits and claims filed against pain management physicians. This study completed in 2020 provides quantitative and qualitative information that a physician 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.
Interventional Radiology: Analysis of Closed Malpractice Claims
Studying interventional radiology malpractice claims provides an understanding of drivers of lawsuits and patient injuries that result. By analyzing these claims and identifying the contributing factors involved, risk mitigation strategies can be developed and implemented reducing adverse patient outcomes and increasing patient safety.
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.
Diagnostic Radiology: Analysis of Closed Malpractice Claims
Studying diagnostic radiology malpractice claims provides an understanding of drivers of lawsuits and patient injuries that result. By analyzing these claims and identifying the contributing factors involved in these, risk mitigation strategies can be developed and implemented reducing adverse patient outcomes and increasing patient safety.
Diagnostic Radiology: A Failure to Diagnose
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.
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.
Prevention of Diagnostic Error in Primary Care
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. 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.
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.
Spotlight on Diagnosing PE/DVT
The overall incidence of venous thromboembolism (VTE) —including both deep vein thrombosis (DVT) and pulmonary embolism (PE) —is one case per 1000 patient years. Accurate and timely diagnosis of VTE can be improved with the use of diagnostic guidelines such as Wells criteria and scoring for both DVT and PE.
Lessons Learned – Plastic Surgery Closed Claims Study: An Expert Analysis of Medical Malpractice Allegations
This course is based on the findings of a study conducted by The Doctors Company that analyzed 415 claims that closed against plastic surgeons (from July 2015–December 2018).
Medical Error Prevention
The purpose of this monograph and continuing medical education activity is to provide physicians with the most current information regarding the prevention of common performance and diagnostic errors.
Safe and Effective Opioid Prescribing – Florida Edition
The Doctors Company recognizes the opioid epidemic in this country. This course provides insights into the risks of opioid usage, as shown by malpractice claims, and how to reduce those risks both for your patient and for your practice. Approved by the Florida Board of Medicine—Controlled Substance Prescribing.
Cauda Equina Syndrome: A Failure to Diagnose
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when patient assessments are incomplete, having a narrow diagnostic focus, or diagnostic test issues. Other factors that hinder timely diagnoses include failure to appreciate signs and symptoms, lack of consults, and failure to respond to repeated patient concerns/symptoms.
Telemedicine to Telehealth: Trends and Emerging Risks
This course explores challenges and risks such as privacy and security, licensure, and technology concerns that might instigate a malpractice claim. The risks overlay the inherent challenge of replicating the interaction of a traditional, in-person encounter between a provider and a patient, without compromising the standard of care. It also provides resources for clinicians and practice managers to consider when making decisions about deploying telehealth services or to improve existing services.
Diagnostic Cardiology Closed Claims Study: An Expert Analysis of Medical Malpractice Allegations
The specialty of cardiology is complex and has underlying vulnerabilities that can put patients at risk of injury and can increase liability for cardiologists and other clinicians who treat heart patients. Understanding common areas of liability and risk exposure are a valuable way to make effective practice improvements.
Making an Informed Consent an Informed Choice: Training for Healthcare Leaders
This activity is designed for healthcare professionals in leadership positions. It covers the principles of informed consent, crafting and disseminating an informed consent policy, and building systems to improve the informed consent process.
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.
Physician-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 a physician-patient relationship, as well as the concerns which may result in the need for the physician to consider terminating the physician-patient relationship. Additionally, the concepts of providing patient centered care will be presented for the learner’s consideration.
General Surgery: Miscommunication and Inaccurate Documentation
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when documentation is inconsistent or not thoroughly read. Other factors that hinder timely diagnosis include inadequate hand-offs or referrals.
Neurosurgery: Communications and System Failure Leading to Diagnostic Error (Claims Corner CME)
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when needed equipment isn’t available or when access to a patient is difficult. System failures may result when there is a lack of coordination of appropriate care among providers, or when poor communication among providers leads to missed and delayed diagnoses.
Jan 24, 2020
A New Generation of Physicians Matures into Patient Safety Leadership
Now in its tenth year, the Academy for Emerging Leaders in Patient Safety offers a multiday immersive patient safety learning experience for healthcare professionals—all of whom make a commitment to complete at least one project to improve patient safety in the field.
Dec 20, 2019
Burnout Can Affect How Patients Communicate
If a physician appears burned out, patients may avoid asking questions for fear of adding to the stress.
Internal Medicine: When Personal Relationships Interfere with the Standard of Care
Physicians and dentists are often faced with the decision whether to treat friends and families without realizing the inherent risks in doing so. A review of one case will highlight some common circumstances and risks associated with the treatment of friends and family members.
Spotlight on Anesthesia Claims: Moving the Needle
In this course we will show how comorbidities complicated the delivery of good anesthesia care. And we will share how important a thorough history and physical is to identifying potential problems that occur in the administration of anesthesia care.
Dec 11, 2019
Cultural Diversity Creates Language Barriers: Reducing Claims with Multilingual Patients
Clear and unambiguous communication constitutes the key component of the physician-patient relationship. Proactively implementing office procedures to promote optimum communication reduces the risk of disputes.
Safe and Effective Opioid Prescribing - Georgia Edition
This three-hour learning activity provides instruction on controlled substance prescribing guidelines, recognizing signs of abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management, as delineated in Georgia Rule 360-15-.01. It also provides tools and resources to assist in educating staff and informing patients.
Prescribing Opioids Safely
Faced with an opioid-related epidemic that continues to bring addiction and deaths, it is important to define the role of opioids for both acute and chronic pain management. This activity spotlights the epidemic and presents the Centers for Disease Control and Prevention (CDC) guidelines, regulations, studies, and emerging solutions to address the epidemic and allow for effective and appropriate use of these drugs.
Safe and Effective Opioid Prescribing - Michigan Edition
This three-hour learning activity provides instruction on controlled substance prescribing guidelines, recognizing signs of abuse or misuse of controlled substances, and requirements delineated in Michigan’s law. It also provides tools and resources to assist in educating staff and informing patients.
Advanced Practice Providers Closed Claims: What Can We Learn?
A recent study by the Association of American Medical Colleges predicts that the U.S. would need an additional 95,900 doctors, 22,700 NPs, and 12,800 PAs immediately if healthcare use patterns were equalized across race, insurance coverage, and geographic location.
More understanding of the liability associated with APPs can help provide insight on the current situation and identify strategies that decrease risk, improve patient safety, and advance patient care.
Oct 05, 2017
Resources and guidelines to help physicians when disclosing adverse events and complications.