Published by Robert Broida on Sep-22-19

According to a recent study in the Journal of the American College of Radiology:

46% of Radiology claims studied were associated with medical care the Emergency Department.

Jeffrey D. Robinson, MD, MBA, from the Department of Radiology at the University of Washington in Seattle, and colleagues examined Emergency Radiology malpractice claims from 18 states from 2012 to 2019, along with publicly-available Medicare data.  The Emergency Department was associated with 46% of the malpractice claims included in the study, while Outpatients were involved in 38% of claims  and Inpatients only 17%.

The authors concluded: “The odds of a claim arising from an ED examination was nearly 4-fold higher in the cohort of malpractice claims than the proportion of ED examinations in the Medicare cohort.”  This “support(s) the hypothesis that ED examinations are at a higher risk of malpractice claims.”

The study reviewed data from 149 radiology exams warehoused by Cleareview, a Seattle-based platform for blind reviews of imaging examinations involved in litigation. Medicare data was used to track the proportion of examinations performed in the ED throughout the United States.

The authors do acknowledge “several potential factors (that) contribute to this imbalance in ED examinations between the malpractice claims and Medicare cohorts.” They note that the Cleareview database only includes cases that were “deemed suitable” for blind review. Claims primarily related to “communications failures, procedural complications or consent complaints,” may not have been submitted for a blind review.

Discussing why more malpractice claims seem to involve ED patients, the authors surmised that it could be due to the fact that ED studies are distributed to a wide range of specialists, or that “the pace and coverage hours demanded by emergency radiology can lead to an increase in diagnostic errors.”

They also note that radiologists reading ED studies may not necessarily have the necessary amount of subspecialized training needed to identify a critical detail. “For example, traumatic injuries often cut across organ systems, so in a given polytrauma victim, findings that may be clear to a musculoskeletal subspecialist may be obscure to a body imager, or vice versa. A neuroradiologist may have difficulty assessing the activity of a flare-up of inflammatory bowel disease. A chest radiologist may not be familiar with the current guidelines around the reporting of nonviable pregnancy.”

Final Thoughts

It should come as no surprise that the ED generates a large percentage of Radiologic malpractice claims.  Emergency Radiology diagnostic error is subject to the same issues that plague Emergency Physicians:

  • Time Sensitivity
  • Patient Load / Coverage Hours
  • Incomplete / Inadequate Patient History
  • Single Visit / Lack of Follow-Up
  • System / Communication Issues
  • Expertise in Multiple Specialties Required

Critical for every hospital to address is the issue of Delays in Final Interpretations.  If the images are not read by the Radiologist in real time, they are read by the Emergency Physician on a Provisional basis. There MUST be a closed loop process to notify all involved parties (Patient, ED, PCP) of any discrepancies discovered with the Final Interpretation by the Radiologist. Emergency Radiology should be a key focus of each hospital’s Quality, Patient Safety and Risk Management Departments.

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