Surgery is the second most common cause for medical malpractice claims against doctors overall, according to a new report from medical liability insurer Coverys.
The insurer analyzed five years of closed medical malpractice claims from 2014 to 2018 and found that surgery-related claims accounted for 25% of the cases. Only diagnosis-related claims, which made up 32% of the claims, resulted in more malpractice cases.
The vast majority (78%) of the 2,579 surgery-related claims were related to practitioner performance during the surgery itself, the report said.
But all phases of the surgical process, including the care and decision-making leading up to and following surgery, can lead to malpractice claims, according to the report.
The top surgical specialties to trigger claims were general surgery (22%), orthopedic surgery (17%) and neurosurgery (8%). Those three types of surgery made up nearly 50% of surgery-related claims, the report found.
Among the claims analyzed, 29% of the injuries from surgery were considered “permanent significant” or worse and 9% resulted in patient deaths.
Most of the claims (39%) alleged a lack of technical skill on the part of the surgeon. Some 27% of surgical claims alleged a failure in clinical judgment and/or communication.
While the majority of claims alleged poor practitioner performance, other problems cited were: leaving a foreign body (7%), performing an unnecessary procedure (4%), wrong side/site/patient (3%) and a delay in surgery (3%).
The report authors said there are specific process vulnerabilities at each stage of the surgical process and offered recommendations to help improve outcomes. For instance, before surgery, physicians should ensure a patient’s participation and understanding using shared decision-making techniques. Surgeons should document comprehensive informed consent discussions, including the patient’s response, in the medical record, the authors advised.
The authors also said it is important to establish a distraction-free environment in the operating room, which might include limiting conversations, turning off cell phone ringers, not playing music and banning visitors or observers while the procedure is taking place.
The authors recommended that hospital operating rooms consider adopting the so-called “sterile cockpit” concept used in aviation, a regulation that prohibits crew members from performing non-essential duties or activities during high-risk activities such as at takeoff and landing.
“Reduction and elimination of activities and distractions, such as excess traffic in the OR and cellphones, permits the OR team to focus on the patient and the task at hand,” the authors said.