- Breakdowns in health information exchange — whether through face-to-face interactions, phone conversations or transactions sourced from electronic medical records — often lead to medical errors and subsequent patient harm. In fact, about one-third of medical malpractice cases can be traced directly to faulty communications, according to recently published report from research and analysis firm CRICO Strategies.
CRICO studied 23,658 malpractice cases filed from 2009 through 2013 and found 7,149 cases in which communication failures contributed to patient harm. The financial impact of those cases totaled $1.7 billion in incurred losses.
Among provider-to-provider interactions analyzed by CRICO, miscommunication regarding the patient’s condition was the top factor leading to failure (26 percent of cases), followed by poor documentation (12 percent) and failure to read the medical record (7 percent). Comparatively, provider-patient breakdowns were most commonly due to inadequate informed consent (13 percent of cases), unsympathetic response to patient complaint (11 percent) and inadequate education regarding medications (5 percent).
The report states that multiple factors can impede safe care: “Workload pressure, cumbersome EHRs, lack of role clarity, distractions, workplace culture (and hierarchies) all contribute to communication failures.” For example, “a nurse of physician says or documents only what is critical before moving on to the next task; a colleague reads or listens with less than full attention amidst the chaos of a busy office or an inpatient unit; a physician sees a patient for a scheduled visit without the expected test results necessary to conduct a thorough examination.”
Of all the cases studied, the largest portion (38 percent) occurred in general medicine settings. Further, most general medicine communication breakdowns occurred in outpatient settings during the diagnostic process. CRICO reported that 42 percent of general medicine miscommunication cases closed with an indemnity payment (11 percent above the overall average) and resulted in an average payout of $386,000.
“All too often, the [primary care provider] is asked or expected to reconcile missing, lost or misinterpreted information before it is too late,” according to the report. CRICO recommends that EHRs, test result and referral management systems, as well as broader clinical communication policies, should be developed “with an underlying patient safety commitment to having the right information in the right hands at the right time.”
The report notes that in many cases a provider named in an allegation of medical malpractice may not be asked via legal proceedings to recall what happened until months or years after the original encounter. “For cases in which inadequate communication brings the standard of care that patient received into question ... recreating undocumented exchanges of information from long ago adds another layer of complexity and doubt,” the report continues. Thus, timely and accurate documentation not only improves patient care, but also minimizes malpractice risk for the provider.
Overall, cases triggered by provider-provider communication failures were significantly more likely to result in an indemnity payment than provider-patient miscommunication cases, the report states. Nearly half (49 percent) of all provider-provider cases closed with a payment, with the average indemnity estimated at $484,000, according to CRICO.