LNCtips.com: Hospitalist Medical Malpractice

Hospitalists are physicians who don't belong to traditional physician practices in which physicians see their patients in the office.  As the name implies, hospitalists only provide care to patients admitted to hospitals, taking the place of the patients' own personal physician as the attending physician.  I'm seeing more cases involving hospitalists and I'm not alone. According to a recent survey, hospitalists are more than twice as likely to have a higher injury severity (72%) than other physician specialists (34%).

All statistics and the discussion below are derived from a study conducted by The Doctors Company, a medical malpractice insurance company.  As the study points out, hospitalists often work with acutely ill patients and have little ability to obtain complete background and histories from them. The top two patient allegations against hospitalists in the study were:

1)  36% Diagnosis related (failure to diagnose, delay in diagnosis, wrong diagnosis).  The most common diagnoses that were incorrect or delayed were related to intestinal conditions, vascular problems, stroke, myocardial infarction, sepsis, pulmonary embolism, spinal epidural abscess, lung cancer, pneumonia, endocarditis, and aortic conditions.

2)  31% Improper management of treatment. This allegation includes correct diagnoses but incorrect management of the care.  For example, hypokalemia might have been the correct diagnosis but potassium was not ordered by the hospitalist.

The remaining patient allegations were medication related errors (11%), improper performance/delay in treatment/procedure (5%), failure to treat (3%), and failure to monitor patient status (3%).

There were a number of factors that contributed to patient injuries.  The top two factors were:

1)  35% Patient assessment issues. This allegation includes failure to determine a differential diagnosis, failure to timely order diagnostic tests, and failure to consider clinical information such as test results or nursing observations.

2)  23% Communication among providers.  This allegation included nurse to physician lack of communication and failure of the physician to review pertinent information in the medical chart.

The remaining factors that contributed to patient injuries were selection and management of therapy (16%), communication between patient/family and provider (12%), failure to obtain a consult/referral (12%), and patient factors (12%).

What does this mean for legal nurse consultants?  If the patient's attending physician was a hospitalist, review the case with an eye to the categories of patient allegations identified above.

...Katy Jones