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Appl Clin Inform 2014; 05(03): 746-756
DOI: 10.4338/ACI-2014-02-RA-0018
Research Article
Schattauer GmbH

Reducing Risk with Clinical Decision Support

A Study of Closed Malpractice Claims
G. Zuccotti
1   Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
3   CRICO/Risk Management Foundation, Cambridge, MA, USA
,
F.L. Maloney
2   Partners HealthCare, Boston, MA, USA
,
J. Feblowitz
1   Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
,
L. Samal
1   Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
,
L. Sato
3   CRICO/Risk Management Foundation, Cambridge, MA, USA
,
A. Wright
1   Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
› Author Affiliations
Further Information

Publication History

received: 03 March 2014

accepted: 04 July 2014

Publication Date:
19 December 2017 (online)

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Summary

Objective: Identify clinical opportunities to intervene to prevent a malpractice event and determine the proportion of malpractice claims potentially preventable by clinical decision support (CDS).

Materials and Methods: Cross-sectional review of closed malpractice claims over seven years from one malpractice insurance company and seven hospitals in the Boston area. For each event, clinical opportunities to intervene to avert the malpractice event and the presence or absence of CDS that might have a role in preventing the event, were assigned by a panel of expert raters. Compensation paid out to resolve a claim (indemnity), was associated with each CDS type.

Results: Of the 477 closed malpractice cases, 359 (75.3%) were categorized as substantiated and 195 (54%) had at least one opportunity to intervene. Common opportunities to intervene related to performance of procedure, diagnosis, and fall prevention. We identified at least one CDS type for 63% of substantiated claims. The 41 CDS types identified included clinically significant test result alerting, diagnostic decision support and electronic tracking of instruments. Cases with at least one associated intervention accounted for $40.3 million (58.9%) of indemnity.

Discussion: CDS systems and other forms of health information technology (HIT) are expected to improve quality of care, but their potential to mitigate risk had not previously been quantified. Our results suggest that, in addition to their known benefits for quality and safety, CDS systems within HIT have a potential role in decreasing malpractice payments.

Conclusion: More than half of malpractice events and over $40 million of indemnity were potentially preventable with CDS.

Citation: G. Zuccotti G, Maloney FL, Feblowitz J, Samal L, Sato L, Wright A. Reducing risk with clinical decision support: A study of closed malpractice claims. Appl Clin Inf 2014; 5: 746–756

http://dx.doi.org/10.4338/ACI-2014-02-RA-0018

Keywords

Malpractice - clinical decision support systems - health information technology - electronic health records - professional liability

 

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