Detecting and Addressing Incidental Findings: Medical Malpractice Claims

With the use of current imaging technology, it has become more common to find abnormalities—or incidental findings—that are unrelated to the reason the imaging was ordered. If the ordering practitioner does not follow up, an incidental finding may lead to patient harm and result in a malpractice claim. To better understand the underlying factors in claims involving incidental findings, The Doctors Company has completed a new analysis.

Study Design

We used an evidence-based taxonomy from Candello¹ to analyze medical malpractice claims from 2007 through 2022 that identified an incidental finding as a contributing factor.

The study criteria included injury severity, major allegation, location of the event, primary and secondary services, role(s) involved, and type of diagnostic test. We also examined other claims from the study period with the word “incidental” in the clinical narrative, even if an incidental finding was not listed as a contributing factor.

Our analysis also considered instances in which no follow up was completed because the practitioner in charge of the patient’s care was either unaware of the finding, did not document it, or did not inform the patient of the finding.

Results

• We found 51 claims with an incidental finding.
• More than 41 percent of the claims included an indemnity payment.
• Injury severity tended to be high or disabling, with many claims involving death.
• The top primary responsible services (that is, the team of practitioners providing care at the time of the event) were emergency medicine, radiology, and primary (family and internal) medicine.
• More than 54 percent of the claims involved two or more responsible services. With that combination, radiology was the top responsible service followed by primary (family and internal) medicine.
• The most common roles: attending or consulting physician, physician assistant, organizational leadership, and clerical staff.
• The most common body locations for incidental findings: lung masses or nodules, kidney lesions, liver masses or nodules, and thyroid masses or nodules.
• We found a number of contributing factors, including the following: issues with clinical systems, communication, documentation, shift work, and a lack of policies and procedures.
• Missed incidental findings do not occur in isolation or from a single missed opportunity.

Conclusion

With the number of incidental findings on the rise, it is imperative for practitioners to be aware of potential problems and establish systems to avoid overlooking new findings. We hope that the insights and strategies presented in our study will help practitioners ensure patient safety and mitigate risk.

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