By The Doctors Company

Emergency medicine physicians are more prone to be sued for diagnosis-related issues than many other specialists because they treat patients who are unknown to them and who have a broad range of clinical problems. A study issued today by the nation's largest physician-owned medical malpractice insurer, showed that one of the top claims against emergency physicians was failure to diagnose, which was also a leading cause of patient injury.

The study of 332 emergency medicine claims that closed from 2007-2013 revealed the four most common patient allegations:

Diagnostic-related issues, such as failure to establish a differential diagnosis or failure to consider available clinical information. (57 percent)

Improper management of treatment, such as failure to stabilize a patient's neck following an accident with trauma to head and neck, resulting in paraplegia. (13 percent)

Improper performance of a treatment or procedure, such as intubation of the respiratory tract. (5 percent)

Failure to order medication, such as not initiating fibrinolytic therapy in acute MI or stroke within the recommended time frames. (3 percent)

Expert physicians reviewed the data and noted that inadequate patient assessment, found in 52 percent of cases, was the number-one contributor to failures in diagnosis. This included not using available clinical information. Other factors that were identified as contributing to patient injury included:

Patient factors, such as obesity, which in some cases delayed the delivery of care due to lack of adequate equipment for treating or evaluating obese patients. (21 percent)

Communication among providers, including failure to review the medical record. (17 percent)

Communication between patient/family and provider, including inadequate follow-up instructions or language barriers. (14 percent)

Insufficient or lack of documentation, including inadequate documentation about clinical findings. (13 percent)

Workflow and workload concerns that included fewer staff or services available on a weekend, night, or holiday. (12 percent)

"This study indicates that the broad base of clinical problems faced by emergency physicians increases risks and highlights the importance of taking steps such as completing a thorough differential diagnosis for each patient," said David B. Troxel. "If an incorrect diagnosis was to occur and documentation shows it was considered and ruled out, that may reduce the physician's liability risk. This study is committed to analyzing our data to anticipate emerging trends and provide insights to reduce risk and promote patient safety."

"I commend The Doctors Company for releasing this important data to assist emergency physicians in identifying areas of improvement," said Roneet Lev, MD, director of operations, at one Emergency Department, in San Diego, California. "The nature of the business of emergency medicine is to be the first to diagnose, but that also means being the first to make the wrong diagnosis. This data will help physicians to focus on specific quality measures that will reduce exposure to malpractice claims and improve patient care."