Background: The intensive care unit (ICU) is a fast-paced setting, in which physicians from different specialties work. The goal of this study is to understand whether characteristics of medical malpractice claims occurring in the ICU differ by physician specialty.
Methods: A retrospective cohort study was performed using a national database called the Comparative Benchmarking System, which is operated by Harvard's malpractice insurer. Claims were included if the harm events occurred in the ICU and closed between 2007-2016. Claims were analyzed according to physician specialty of the "primary responsible provider," which was the physician most directly involved in the harm event. Patient-, provider- and claim-level characteristics were compared among the 6 most common physician specialties that were identified as "primary responsible provider." Multivariable regression was performed to identify factors associated with claim payment.
Results: Of 54,772 claims, 1,113 resulted from harm events in the ICU, of which 843 involved the following physician specialties: internal medicine (305), cardiology (163), pulmonary medicine (149), general surgery (98), neurology (97) and anesthesia (31). The minority of claims across physician specialties originated in academic medical centers (<30%). The most common severity of harm was death (Range 42-72%, P = 0.0001). The frequency with which claims involved procedures varied by physician specialty (Range 24-84%, P < 0.0001). The 3 most common contributing factors (patient assessment, selection/management of therapies and communication among providers) did not differ by physician specialty. In multivariable regression, claims that were procedure-related were statistically more likely to result in payment (Odds Ratio 2.29, 95% Confidence Interval 1.64-3.20), after adjusting for physician specialty.
Conclusions: There were few unexpected differences in malpractice claims occurring in the ICU by physician specialty. Prevention efforts could focus on procedures, regardless of physician specialty, including: 1) maintaining procedural skills, 2) framing procedural risks well and 3) accurately describing procedural complications after they happen.
Keywords: critical care medicine; intensive care unit; medical malpractice; patient safety.