The Malpractice Experience of Neurosurgeons 2014–2019: Patient Selection and Communication May Mitigate Risk of Claims (Abstract)

Even when all care provided falls well within the standard of care, surgical interventions by neurosurgeons can have serious complications. The inherent risks of neurosurgery motivate our overarching goal for this study, which is to help physicians and healthcare organizations integrate evidence-based recommendations into clinical practice. In this study, The Doctors Company examines the allegations, initial and final diagnoses, procedures, injuries, sites, locations, severity, comorbidities, contributing factors, indemnities, and expenses paid in medical malpractice claims against neurosurgeons. The purpose of this study was to identify what most often leads to claims and suggest best practices for risk mitigation.

Study Design

In February 2021, The Doctors Company conducted an analysis of medical malpractice claims against neurosurgeons that closed between the years of 2014 and 2019. This evaluation included 302 claims and lawsuits, and examined allegations, diagnoses, procedures, and contributing factors, as well as indemnities and expenses paid. The claims experience of neurosurgeon members of The Doctors Company was then benchmarked against a national sample of other neurosurgeons.

Results

• The two most common allegations against neurosurgeons were improper performance of surgery (40 percent of claims) and improper management of the surgical patient (33 percent of claims).
• Technical performance was the greatest factor leading to patient injury (65 percent of claims).
• Patient assessment issues were also prominent among contributing factors (29 percent of claims), alongside selection and management of therapy (27 percent of claims).
• Diagnosis-related allegations made up only 10 percent of claims, but communication among providers about the patient’s condition was an important factor leading to patient injury in these claims, appearing in 28 percent of studied cases in this category.
• Many claims alleging technical performance issues involved diagnostic tests:
  • Improper management of the surgical patient (26 percent of these claims alleged CT scans were delayed or not ordered).
  • Improper performance of surgery (22 percent of these claims alleged CT scans were delayed or not ordered).

Conclusion

For neurosurgery, as for most surgical specialties, technical performance issues rise to prominence when reviewing closed claims. To reduce technical performance risks, a surgeon who has less experience performing a particular procedure may benefit from involvement by one who has more; physicians and patients benefit when organizational cultures foster such collaboration as part of their culture of safety, along with time-outs and other communication strategies.

Clinicians should hone strategies for risk reduction through careful patient selection and clear communication with patients. All parties benefit when clinicians set reasonable patient expectations about outcomes, discuss the possibility of complications and/or less-than-optimal results, and link back to these conversations when an undesirable outcome occurs.

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