title: Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.
abstract: OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the most frequent contributing factors should be instituted in care redesign strategies, enabling strategic alignment of quality improvement and risk management efforts.
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and.
authors.forename: Nancy
authors.initials: N
authors.lastname: McLaughlin
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Garrett
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and.
authors.forename: Leila
authors.initials: L
authors.lastname: Emami
authors.affiliation: Department of Risk Management, University of California, Los Angeles, California.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Foss
authors.affiliation: Department of Risk Management, University of California, Los Angeles, California.
authors.forename: Johanna L
authors.initials: JL
authors.lastname: Klohn
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martin
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D006801:Humans; D007600:Judgment; D016365:Liability, Legal; D008318:Malpractice / Q000191:economics / Q000706:statistics & numerical data*; D009493:Neurosurgery / Q000193:education* / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D015279:Organizational Culture; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D012308:Risk Management / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: CRIT = Comprehensive Risk Intelligence Tool; MRMC = Medical Risk Management Committee; RRMC = Ronald Reagan Medical Center; SMMC = Santa Monica Medical Center; UCLA = University of California, Los Angeles; culture; liability; neurosurgery; process improvement; quality; risk management; value