Emergency Physician Practice Changes After Being Named in a Malpractice Claim

• Published in: Annals of emergency medicine Vol. 75; no. 2; pp. 221 - 235
• Main Authors: Carlson, Jestin N., MD, MS, Foster, Krista M., MS, Black, Bernard S., JD, Pines, Jesse M., MD, MBA, Corbit, Christopher K., MD, Venkat, Arvind, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2020
• Subjects: Adult; Case-Control Studies; Defensive Medicine; Emergency; Emergency Medicine - legislation & jurisprudence; Female; Humans; Length of Stay; Male; Malpractice; Middle Aged; Patient Satisfaction; Practice Patterns, Physicians; Propensity Score; Relative Value Scales; Retrospective Studies; United States; United States
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2019.07.007

Study objectiveMalpractice fear is a commonly cited cause for defensive medicine, but it is unclear whether being named in a malpractice claim changes physician practice patterns. We study whether there are changes in commonly used measures of emergency physician practice after being named in a malpractice claim. MethodsWe performed a retrospective difference-in-differences study comparing practice patterns of emergency physicians named in a malpractice claim and unnamed matched controls working contemporaneously in the same emergency departments (EDs), using data from a national emergency medicine management group (59 EDs in 11 US states from 2010 to 2015). We studied aggregate measures of care intensity (hospital admission rate and relative value units/visit), studied care speed (relative value units/hour and discharged patients’ length of stay), and assessed patient experience (monthly physician Press Ganey percentile rank). ResultsA total of 65 emergency physicians named in at least 1 malpractice claim and 140 matched controls met inclusion criteria. After the malpractice claim filing date, there were no significant changes in measures of care intensity or speed. However, named emergency physicians’ patient experience scores improved immediately after the malpractice claim filing date and showed sustained improvements by 6.52 Press Ganey percentile ranks (95% confidence interval 0.67 to 12.38), with the increase most prominent among those involved in the 46 failure-to-diagnose claims (10.52; 95% confidence interval 3.72 to 17.32). ConclusionWe observed a temporal improvement in patient satisfaction scores for emergency physicians in this sample after their being named in a malpractice claim relative to matched controls. Measures of care intensity and speed did not significantly change.