Physician researchers from Brigham and Women’s Hospital were interested in learning from medical malpractice claims related to anesthesiology. Working with analysts from CRICO, they analyzed data from the Comparative Benchmarking System (Candello) related to anesthesiology and published peer-review studies of their findings, each one offering different insights. 

While medical professional liability (MPL) claims may occur infrequently, these seemingly rare incidences directly correspond to the more common adverse event data. When organizations have few claims—a good thing, indeed—they may look to leverage a larger data set in order to help shed light on a rare, but serious complication.

The volume of cases in Candello—representing approximately 30 percent of all U.S. medical malpractice claims—makes it possible analyze specialty areas that may have fewer claims at an organizational level yet have a large enough "n" in Candello to gain insights. The below screen shot shows that there are 2,942 closed MPL claims in Candello, between 2008–2019 that name anesthesiology as the responsible service.

Data from the Clinical Event Search Engine tool as of 7/1/2021.

This information provides valuable insights about the frequency these cases close with indemnity payment, the top contributing factors, clinical severity, and top major injuries. While this data tool provides high-level information about these kinds of events, a more targeted analysis can be done of Candello data enabling organizations to pinpoint specific procedures, injuries, locations, etc. or other data points that are captured using the taxonomy.

The below listing of peer-review studies demonstrates how targeted analyses can be conducted using Candello data.

INSIGHTS FROM ANESTHESIOLOGY-RELATED MPL CLAIMS

1. A contemporary medicolegal analysis of outpatient interventional pain procedures between 2009 and 2016

Publication: Anesthesia & Analgesia

Researchers set out to explore what insights for patient safety and physician professional liability are revealed through analysis of malpractice claims involving outpatient chronic pain procedures. Findings from this analysis demonstrated that epidural steroid injections are among the most commonly performed interventional pain procedures and, while a familiar procedure to pain management practitioners, may result in significant neurological injury.

2. A closed claims analysis of vocal cord injuries related to endotracheal intubation between 2004 and 2015

Publication: Journal of Clinical Anesthesia

This analysis was to help researchers better understand claims against anesthesiologists for vocal cord injuries that occurred during endotracheal intubation. Findings indicate that the cause of injuries was often multifactorial and stemmed most commonly from technical errors and patients with comorbidities.

3. Analysis of adverse outcomes in the post-anesthesia care unit based on anesthesia liability data

Publication: Journal of Clinical Anesthesia

The aim of this study was to provide a contemporary medicolegal analysis of claims brought against anesthesiologists in the United States for events occurring in the post-anesthesia care unit (PACU). Appropriate monitoring of patients by responsible providers in the PACU is crucial to timely diagnosis of potentially severe complications, as missed and delayed diagnoses were a factor in a number of the cases reviewed.

4. A contemporary analysis of medicolegal issues in obstetric anesthesia between 2005 and 2015

Publication: Anesthesia & Analgesia

Researchers investigated the relationship among contributing factors, patient injuries, and legal outcome by analyzing a contemporary cohort of closed malpractice where obstetric anesthesiology was the principal defendant. Opportunities for practice improvement in the area of severe maternal injury include timely recognition of high neuraxial block, availability of adequate resuscitative resources, and the use of advanced airway management techniques.

5. A medicolegal analysis of malpractice claims involving anesthesiologists in the gastrointestinal endoscopy suite (2007–2016)

Publication: Journal of Clinical Anesthesia

Gastrointestinal endoscopy cases make up the largest portion of “out of operating room” malpractice claims involving anesthesiologists. This study identifies associated case characteristics and contributing factors that resulted from the gastrointestinal endoscopy suite.

6. A contemporary medicolegal analysis of outpatient medication management in chronic pain

Publication: Anesthesia & Analgesia.

The goal of this study was to identify patient medical comorbidities and aberrant drug behaviors, as well as prescriber practices associated with patient injury and malpractice claims. Through this analysis researchers concluded that claims related to outpatient medication management in pain medicine are multifactorial, stemming from deficits in clinical judgment by physicians, non-cooperation in care by patients, and poor clinical documentation.

7. A contemporary medicolegal analysis of implanted devices for chronic pain management

Publication: Anesthesia and Analgesia

Researchers studied complications associated with intrathecal drug delivery systems and spinal cord stimulators. This study illustrates how data from the national Comparative Benchmarking System (Candello) can shed light on a rare, but serious complication. Due to the high volume of claims in the Candello database, researchers were able to identify the risks and contributing factors associated with this type of injury. Researchers determined that deficits in technical skill were the most common contributing factor to injury, followed by deficits in clinical judgment, communication, and documentation.

CITATIONS

1. Abrecht CR, Saba R, Greenberg P,  Rathmell JP, Urman RD. A contemporary medicolegal analysis of outpatient interventional pain procedures between 2009 and 2016.  Anesthesia & Analgesia. Jul 2019, 129(1):255–262. http://dx.doi.org/10.1213/ANE.0000000000004096 (Subscription may be required)
2. Homsi JT, Brovman EY, Greenberg P, Urman RD. A closed claims analysis of vocal cord injuries related to endotracheal intubation between 2004 and 2015. Journal of Clinical Anesthesia. 2020 May. 61 [published online Dec. 10, 2019]. https://doi.org/10.1016/j.jclinane.2019.109687 
3. Kellner DB, Urman RD, Greenberg P, Brovman EY. Analysis of adverse outcomes in the post-anesthesia care unit based on anesthesia liability data. Journal of Clinical Anesthesia. 2018;50:48-56. doi:10.1016/J.JCLINANE.2018.06.038. [Epub ahead of print] (Subscription may be required.)
4. Kovacheva VP, MD, Brovman EY, Greenberg P, Song E, Palanisamy A, Urman RD. A contemporary analysis of medicolegal issues in obstetric anesthesia between 2005 and 2015. Anesthesia & Analgesia. May 10, 2018 [ahead of print]. http://dx.doi.org/10.1213/ANE.0000000000003395. (Subscription may be required.) 
5. Stone AB, Brovman EY, Greenberg P, Urman RD. A medicolegal analysis of malpractice claims involving anesthesiologists in the gastrointestinal endoscopy suite (2007–2016). Journal of Clinical Anesthesia. 2018;48:15-20. doi:10.1016/j.jclinane.2018.04.007. (Subscription may be required.)
6. Abrecht CR, Brovman EY, Greenberg P, Song E, Rathmell JP, Urman RD. A contemporary medicolegal analysis of outpatient medication management in chronic pain. Anesthesia & Analgesia. 2017 Nov;125(5):1761-1768. doi: 10.1213/ANE.0000000000002499. (subscription may be required)
7. Abrecht CR, Greenberg P, Song E, Urman RD, Rathmell JP. A contemporary medicolegal analysis of implanted devices for chronic pain management. Anesthesia and Analgesia. April 2017;124(4):1304-1310. doi: 10.1213/