MedStar Health, a nationally recognized network of 10 academic and community hospitals in the Baltimore/Washington DC corridor, joined the Candello community in 1999. Clinical coding and analysis of their medical professional liability (MPL) cases has led to measurable improvements in Emergency Medicine.

The following is excerpted from previously published case study that was written with MedStar Health. It looks at an example of how the health system leveraged signals from its medical malpractice data to inform patient safety initiatives.

Medstar at a glanceAfter the 1999 IOM Report shone a light on the impact of medical errors in hospitals across the country, MedStar leaders sought to understand specific drivers of vulnerability in their hospitals and develop targeted interventions to improve care in high risk areas. That year, MedStar engaged CRICO Strategies in what has become a long-term partnership that leverages MPL data to improve patient safety. Since then, MedStar has implemented several targeted risk reduction initiatives that have resulted in measurable, quantifiable change.

Emergency Medicine


Candello’s team of clinical specialists partnered with MedStar to deeply analyze its MPL claims:

  • Clinical experts reviewed legal files and medical records and applied Candello’s clinical coding taxonomy to capture clinical and system factors driving their losses.
  • This enabled MedStar’s MPL profile to be analyzed and compared against a group of its peer organizations using Candello’s analytical tool, the Comparative Benchmarking System (CBS).
  • These comparative analyses revealed MedStar’s unique challenges and empowered leaders to intervene on key risks.


Analysis of 10 years of richly coded claims data revealed misdiagnosed injuries from atraumatic spinal cord compression as a significant driver of clinical harm and financial losses. These data showed that losses were related to diagnostic errors and poor communication resulting in delayed diagnosis and treatment, primarily in patients presenting to MedStar’s Emergency Department. Using these data, MedStar initiated a system-wide loss prevention initiative aimed at reducing spinal cord related claims.


ED Task Force: Based on findings from their MPL analysis, MedStar formed a multi-specialty clinical task force to further investigate the clinical and systems factors driving these losses and develop solutions to prevent similar future harms.

Supporting Safe Clinical Judgment: With data demonstrating the specific source of losses and the significance of its impact, the ED Task Force was positioned to develop targeted solutions to support clinicians’ judgment in diagnosing these injuries.

Recognizing that these rare atraumatic spinal cord compressions are difficult to detect and diagnose, the Task Force developed a system-wide web-based educational program to support early detection and management of this condition, which includes a review of the anatomy and pathology of the condition and concrete suggestions for diagnosis and treatment.

The task force also developed a spinal cord diagnostic algorithm that is triggered once a preliminary assessment suggests that spinal cord compression could be included within the differential diagnosis.

Improving Communication Among Providers: With data pinpointing communication challenges between ordering physicians and the MRI suite as a significant cause of these delays in treatment and diagnosis, the Task Force developed and implemented a system-wide STAT order sheet to facilitate sharing of clear, unambiguous information between the ordering physician and the MRI suite.


MedStar’s ED Task Force—now its new system-wide Emergency Medicine Leadership Council—continues to monitor the effectiveness of these changes. As of 2015 when the case study was originally published, MedStar experienced no reported adverse events involving atraumatic spinal cord compression injuries.

As a result of these and other data-driven interventions, MedStar has seen measurably improved outcomes and demonstrably safer care for its patients. MedStar continues to analyze its MPL claims in an ongoing manner and these data have continued to inform its patient-centered risk reduction initiatives for more than 15 years.

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