Analysis of surgical errors in closed malpractice claims at 4 liability insurers

Selwyn O. Rogers, Atul A. Gawande, Mary Kwaan, Ann Louise Puopolo, Catherine Yoon, Troyen A. Brennan, David M. Studdert

Research output: Contribution to journalArticle

233 Citations (Scopus)

Abstract

Background: The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical error and identify opportunities for prevention. Methods: We retrospectively reviewed 444 closed malpractice claims, from 4 malpractice liability insurers, in which patients alleged a surgical error. Surgeon-reviewers examined the litigation file and medical record to determine whether an injury attributable to surgical error had occurred and, if so, what factors contributed. Detailed descriptive information concerning etiology and outcome was recorded. Results: Reviewers identified surgical errors that resulted in patient injury in 258 of the 444 (58%) claims. Sixty-five percent of these cases involved significant or major injury; 23% involved death. In most cases (75%), errors occurred in intraoperative care; 25% in preoperative care; 35% in postoperative care. Thirty-one percent of the cases had errors occurring during multiple phases of care; in 62%, more than 1 clinician played a contributory role. Systems factors contributed to error in 82% of cases. The leading system factors were inexperience/lack of technical competence (41%) and communication breakdown (24%). Cases with technical errors (54%) were more likely than those without technical errors to involve errors in multiple phases of care (36% vs 24%, P = .03), multiple personnel (83% vs 63%, P < .001), lack of technical competence/knowledge (51% vs 29%, P < .001) and patient-related factors (54% vs 33%, P = .001). Conclusions: Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors.

Original languageEnglish (US)
Pages (from-to)25-33
Number of pages9
JournalSurgery
Volume140
Issue number1
DOIs
StatePublished - Jul 2006
Externally publishedYes

Fingerprint

Medical Errors
Insurance Carriers
Malpractice
Insurance Claim Review
Mental Competency
Wounds and Injuries
Intraoperative Care
Preoperative Care
Postoperative Care
Jurisprudence
Medical Records
Communication

ASJC Scopus subject areas

  • Surgery

Cite this

Rogers, S. O., Gawande, A. A., Kwaan, M., Puopolo, A. L., Yoon, C., Brennan, T. A., & Studdert, D. M. (2006). Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery, 140(1), 25-33. https://doi.org/10.1016/j.surg.2006.01.008

Analysis of surgical errors in closed malpractice claims at 4 liability insurers. / Rogers, Selwyn O.; Gawande, Atul A.; Kwaan, Mary; Puopolo, Ann Louise; Yoon, Catherine; Brennan, Troyen A.; Studdert, David M.

In: Surgery, Vol. 140, No. 1, 07.2006, p. 25-33.

Research output: Contribution to journalArticle

Rogers, SO, Gawande, AA, Kwaan, M, Puopolo, AL, Yoon, C, Brennan, TA & Studdert, DM 2006, 'Analysis of surgical errors in closed malpractice claims at 4 liability insurers', Surgery, vol. 140, no. 1, pp. 25-33. https://doi.org/10.1016/j.surg.2006.01.008
Rogers SO, Gawande AA, Kwaan M, Puopolo AL, Yoon C, Brennan TA et al. Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery. 2006 Jul;140(1):25-33. https://doi.org/10.1016/j.surg.2006.01.008
Rogers, Selwyn O. ; Gawande, Atul A. ; Kwaan, Mary ; Puopolo, Ann Louise ; Yoon, Catherine ; Brennan, Troyen A. ; Studdert, David M. / Analysis of surgical errors in closed malpractice claims at 4 liability insurers. In: Surgery. 2006 ; Vol. 140, No. 1. pp. 25-33.
@article{f3197f1d96e24b21a22c84625748519c,
title = "Analysis of surgical errors in closed malpractice claims at 4 liability insurers",
abstract = "Background: The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical error and identify opportunities for prevention. Methods: We retrospectively reviewed 444 closed malpractice claims, from 4 malpractice liability insurers, in which patients alleged a surgical error. Surgeon-reviewers examined the litigation file and medical record to determine whether an injury attributable to surgical error had occurred and, if so, what factors contributed. Detailed descriptive information concerning etiology and outcome was recorded. Results: Reviewers identified surgical errors that resulted in patient injury in 258 of the 444 (58{\%}) claims. Sixty-five percent of these cases involved significant or major injury; 23{\%} involved death. In most cases (75{\%}), errors occurred in intraoperative care; 25{\%} in preoperative care; 35{\%} in postoperative care. Thirty-one percent of the cases had errors occurring during multiple phases of care; in 62{\%}, more than 1 clinician played a contributory role. Systems factors contributed to error in 82{\%} of cases. The leading system factors were inexperience/lack of technical competence (41{\%}) and communication breakdown (24{\%}). Cases with technical errors (54{\%}) were more likely than those without technical errors to involve errors in multiple phases of care (36{\%} vs 24{\%}, P = .03), multiple personnel (83{\%} vs 63{\%}, P < .001), lack of technical competence/knowledge (51{\%} vs 29{\%}, P < .001) and patient-related factors (54{\%} vs 33{\%}, P = .001). Conclusions: Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors.",
author = "Rogers, {Selwyn O.} and Gawande, {Atul A.} and Mary Kwaan and Puopolo, {Ann Louise} and Catherine Yoon and Brennan, {Troyen A.} and Studdert, {David M.}",
year = "2006",
month = "7",
doi = "10.1016/j.surg.2006.01.008",
language = "English (US)",
volume = "140",
pages = "25--33",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Analysis of surgical errors in closed malpractice claims at 4 liability insurers

AU - Rogers, Selwyn O.

AU - Gawande, Atul A.

AU - Kwaan, Mary

AU - Puopolo, Ann Louise

AU - Yoon, Catherine

AU - Brennan, Troyen A.

AU - Studdert, David M.

PY - 2006/7

Y1 - 2006/7

N2 - Background: The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical error and identify opportunities for prevention. Methods: We retrospectively reviewed 444 closed malpractice claims, from 4 malpractice liability insurers, in which patients alleged a surgical error. Surgeon-reviewers examined the litigation file and medical record to determine whether an injury attributable to surgical error had occurred and, if so, what factors contributed. Detailed descriptive information concerning etiology and outcome was recorded. Results: Reviewers identified surgical errors that resulted in patient injury in 258 of the 444 (58%) claims. Sixty-five percent of these cases involved significant or major injury; 23% involved death. In most cases (75%), errors occurred in intraoperative care; 25% in preoperative care; 35% in postoperative care. Thirty-one percent of the cases had errors occurring during multiple phases of care; in 62%, more than 1 clinician played a contributory role. Systems factors contributed to error in 82% of cases. The leading system factors were inexperience/lack of technical competence (41%) and communication breakdown (24%). Cases with technical errors (54%) were more likely than those without technical errors to involve errors in multiple phases of care (36% vs 24%, P = .03), multiple personnel (83% vs 63%, P < .001), lack of technical competence/knowledge (51% vs 29%, P < .001) and patient-related factors (54% vs 33%, P = .001). Conclusions: Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors.

AB - Background: The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical error and identify opportunities for prevention. Methods: We retrospectively reviewed 444 closed malpractice claims, from 4 malpractice liability insurers, in which patients alleged a surgical error. Surgeon-reviewers examined the litigation file and medical record to determine whether an injury attributable to surgical error had occurred and, if so, what factors contributed. Detailed descriptive information concerning etiology and outcome was recorded. Results: Reviewers identified surgical errors that resulted in patient injury in 258 of the 444 (58%) claims. Sixty-five percent of these cases involved significant or major injury; 23% involved death. In most cases (75%), errors occurred in intraoperative care; 25% in preoperative care; 35% in postoperative care. Thirty-one percent of the cases had errors occurring during multiple phases of care; in 62%, more than 1 clinician played a contributory role. Systems factors contributed to error in 82% of cases. The leading system factors were inexperience/lack of technical competence (41%) and communication breakdown (24%). Cases with technical errors (54%) were more likely than those without technical errors to involve errors in multiple phases of care (36% vs 24%, P = .03), multiple personnel (83% vs 63%, P < .001), lack of technical competence/knowledge (51% vs 29%, P < .001) and patient-related factors (54% vs 33%, P = .001). Conclusions: Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors.

UR - http://www.scopus.com/inward/record.url?scp=33745958652&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745958652&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2006.01.008

DO - 10.1016/j.surg.2006.01.008

M3 - Article

C2 - 16857439

AN - SCOPUS:33745958652

VL - 140

SP - 25

EP - 33

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 1

ER -