Malpractice Risk and Vulnerabilities Ambulatory Obstetrics and Gynecology Practice [6I

Abstract

INTRODUCTION: Malpractice claims may play an important role in the high cost of health care and may provide a lens through which patient’s perspectives of healthcare deficiencies are revealed. Learning from potential mistakes - or from the patient’s perception of harm - can help to identify areas for improvement in patient care. METHODS: This is a retrospective cohort study of claims from the CRICO Strategies National Comparative Benchmarking System (CBS) for malpractice cases asserted during the period 2006 and 2016. Cases selected for this analysis were open and closed malpractice claims and lawsuits from obstetric outpatient claims. Cases meeting selection criteria were qualitatively analyzed to determine contributing factors prompting harm and/or perceived harm. RESULTS: Of the 113,932 malpractice claims during this ten year period, 2,730 were obstetric-related, 548 originated within the outpatient setting, and 296 were associated with severe patient harm and/or death. Of these 296 claims, the top 5 contributing factors leading to the filing of the claim were perceived lapse of clinical judgment (45%), ineffective communication (25%), poor documentation (14%), clinician behavior related (11%), and clinical systems breakdown (11%). CONCLUSION: This review provides insight into vulnerabilities within the outpatient obstetrics setting and identifies areas for improvement. To provide safe and effective care, clinicians and administrators need to understand malpractice vulnerabilities and develop strategies to reduce risk. Our data suggests that the development of training or tools to support clinical decision making, communication strategies, and appropriate documentation are priority areas to reduce malpractice risk in the outpatient obstetrics setting.