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Factors Associated with Malpractice Claim Payout: An Analysis of Closed Emergency Department Claims

      In the United States, practicing emergency medicine carries a high risk of medical malpractice claims. Analysis of malpractice claims has yielded actionable strategies for reducing risk in this setting,
      • Lemoine N
      • et al.
      Understanding diagnostic safety in emergency medicine: a case-by-case review of closed ED malpractice claims.
      but several of the studies took place before major advances in patient safety and widespread implementation of electronic health records.
      • Kachalia A
      • et al.
      Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers.
      ,
      • Brown TW
      • et al.
      An epidemiologic study of closed emergency department malpractice claims in a national database of physician malpractice insurers.
      Although a more recent analysis of closed emergency department (ED) claims revealed diagnostic error to be the most frequently cited error, the study did not delve into possible contributing factors.
      • Wong KE
      • et al.
      Emergency department and urgent care medical malpractice claims 2001–15.
      Older studies have found that predominant contributing factors for ED claims were gaps in the diagnostic process, including failure to order necessary diagnostic testing, inadequate history and physical examination, and lack of appropriate subspecialty consultation.
      • Kachalia A
      • et al.
      Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers.
      ,
      • Elshove-Bolk J
      • et al.
      A description of emergency department-related malpractice claims in the Netherlands: closed claims study 1993–2001.
      An updated assessment of contributing factors to ED claims is needed to understand whether diagnostic process failures persist at high levels in order to make investments in patient safety that tackle the key drivers. We therefore examined the contributing factors in 799 recent closed ED claims from a large, national liability insurer.
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