Every medical malpractice claim or lawsuit states or implies an allegation of negligent or substandard care. The allegation frames the plaintiff’s connection between the health care the patient expected and an adverse outcome of that care.
For every MPL case entered into CRICO’s national Comparative Benchmarking System (CBS), the clinical coding specialist must assign a major allegation that best identifies the plaintiff’s complaint. Depending on the source of the malpractice claim or lawsuit, the plaintiff’s allegation may be clearly stated, implied, or obscured by a focus on individuals or tangential interactions rather than the clinical scenario. The coding specialists strive to assign a specific allegation that will clarify the claimant’s argument, an essential step toward understanding the events in question and guiding future patient safety improvement efforts.
Within the allegation categories, the coding specialists have a set of specific major allegation types by which they can define a case, as well as secondary allegation types they can include when appropriate. The top 10 specific allegations—which account for 75% of cases and 81% of incurred losses—are described below. (Note that the diagnosis-related category has only one allegation choice.)
As with any exploration of medical malpractice data, a data source large enough to generate credible evidence is key to being able to illustrate the distribution of cases across various domains. Allegation type is a valuable tool for understanding what aspects of care are most likely to trigger claims of malpractice. Drilling down into the subtypes of those allegations (e.g., the difference between surgical performance and surgery patient management) is an important next step in guiding your organization’s patient safety attention and resources in the most appropriate direction. Exploration of root causes and implementation of interventions/best practices based on a more detailed understanding of adverse event patterns are more likely to lead to effective patient safety improvements.
May 2018 | by Jock Hoffman