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- Title
Characterizing malpractice cases involving emergency department advanced practice providers, physicians in training, and attending physicians.
- Authors
Antkowiak, Peter S.; Lai, Shin‐Yi; Burke, Ryan C.; Janes, Margaret; Zawi, Tarek; Shapiro, Nathan I.; Rosen, Carlo L.
- Abstract
Objective: The objective was to evaluate available characteristics and financial costs of malpractice cases among advanced practice providers (APPs; nurse practitioners [NPs] and physician assistants [PAs]), trainees (medical students, residents, fellows), and attending physicians. Methods: This study was a retrospective analysis of claims occurring in the emergency department (ED) from January 1, 2010, to December 31, 2019, contained in the Candello database. Cases were classified according to the provider type(s) involved: NP, PA, trainee, or cases that did not identify an extender as being substantially involved in the adverse event that resulted in the case ("no extender"). Results: There were 5854 cases identified with a total gross indemnity paid of $1,007,879,346. Of these cases, 193 (3.3%) involved an NP, 513 (8.8%) involved a PA, 535 (9.1%) involved a trainee, and 4568 (78.0%) were no extender. Cases where a trainee was involved account for the highest average gross indemnity paid whereas no‐extender cases are the lowest. NP and PA cases differed by contributing factors compared to no‐extender cases: clinical judgment (NP 89.1% vs. no extender 76.8%, p < 0.0001; PA 84.6% vs. no extender, p < 0.0001), documentation (NP 23.3% vs. no extender 17.8%, p = 0.0489; PA 25.9% vs. no extender, p < 0.0001), and supervision (NP 22.3% vs. no extender 1.8%, p < 0.0001; PA 25.7% vs. no extender p < 0.0001). Cases involving NPs and PAs had a lower percentage of high‐severity cases such as loss of limb or death (NP 45.6% vs. no extender 50.2%, p = 0.0004; PA 48.3% vs. no extender, p < 0.0001). Conclusions: APPs and trainees comprise approximately 21% of malpractice cases and 33% of total gross indemnity paid in this large national ED data set. Understanding differences in characteristics of malpractice claims that occur in emergency care settings can be used to help to mitigate provider risk.
- Subjects
HOSPITAL emergency services; HOSPITAL medical staff; MEDICAL students; RETROSPECTIVE studies; FISHER exact test; DOCUMENTATION; HEALTH insurance reimbursement; T-test (Statistics); MALPRACTICE; CHI-squared test; DESCRIPTIVE statistics; NURSE practitioners; PHYSICIANS; ADVERSE health care events; DECISION making in clinical medicine; SUPERVISION of employees; DATA analysis software
- Publication
Academic Emergency Medicine, 2023, Vol 30, Issue 12, p1237
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/acem.14800