Office-Based Medical Malpractice Claims: Study Examines Administrative and Clinical Systems Factors

Ensuring patient safety is the goal in each office encounter. As evidenced by medical malpractice claims, however, harmful errors can occur that lead to poor outcomes for patients. To better understand the underlying administrative and clinical systems factors that contribute to office-based medical malpractice claims, The Doctors Company has released a new study.

Study Design

Our study covered office-based medical malpractice claims closed from 2011 through 2022 with administrative and clinical systems factors.

Recent updates to the coding taxonomy¹ enabled us to link the contributing factors in claims to both the service (for example, family medicine) and the role (for example, attending physician) and to add primary drivers as a weighting element. Primary drivers are factors determined to be the most likely to have led to an error or claim.

The aim of our analysis was to describe characteristics of the claims, identify the roles associated with them, determine the primary drivers, and provide effective risk mitigation strategies.

Results

• Most of the injuries were of medium severity, with the top major allegations related to diagnosis and medical treatment.
• Family medicine was the top primary responsible service.
• We identified 20 different roles associated with office-based claims. Organizational leadership, which accounted for 40 percent of the roles, was responsible for administrative matters (such as staff issues, policies, and protocols), while the attending or consulting physician (33 percent) had more accountability for clinical systems.
• A high percentage of claims had a paid indemnity (59 percent), with diagnosis-related allegations having both a large percentage of high injury severity (65 percent) and paid indemnity claims (61 percent).
• Three of the top five primary drivers in office-based claims were administrative in nature. Primary drivers around policies and protocols and staff training were prominent.
• Another top primary driver involved lack of or failure in a clinical system, particularly in communicating about test results or follow-up appointments when expectations about actions taken were unclear.

Conclusion

Learning from claims can assist in identifying possible weaknesses within office-based practices. We hope these insights will help healthcare professionals prevent future errors, reduce patient harms, and mitigate risk.