The study looked at 1,895 claims against orthopedists that closed between 2007 and 2014 including all claims and lawsuits in which an orthopedist was named a defendant. The company included all cases in the study regardless of the outcome to get a broader sense of what motivates a patient to pursue a claim and to gain a better understanding of system failures and what led to patient harm.
Here is what you need to know:
1. The highest majority of claims, 46 percent, came from patients claiming their surgery was performed improperly. The allegation was most often made when the outcome of the procedure differed from the patient's perspective. A patient's perception was not consistent with the findings of expert reviewers, who claimed that only a small percentage of injuries were due to substandard care.
2. Total knee replacement, total hip replacement, knee arthroscopy, vertebroplasty, open reduction internal fixation, discectomy, exploration and decompression of spinal canal, shoulder arthroscopy and rotator cuff repair were the procedures that most often and allegations of improper care.
3. Improper management of surgical patients made up 16 percent of all claims. These cases often involved clinical decisions and care provided postoperatively to patients. Patients often claimed improper management if they experienced infections, malunion or nonunion of bones, continued pain or mechanical complications of orthopedic devices. These issues required the repair of the device or in some case amputation.
4. A failed, delayed or wrong diagnosis accounted for 13 percent of the claim. The most incorrectly diagnosed procedures include compartment syndrome, fractures, nonunion of fracture, hematomas, postoperative infections, malignant bone tumors, thromboembolism and dislocations.
5. Patients were more likely to file a claim if they received an injury from the surgery or soon thereafter. A large factor contributing to that was whether a patient who suffered an injury understood the cause or outcome of the injury. The company identified several factors that contributed to patient injury.
6. Technical performance accounted for 35 percent of all patient injury, although that doesn't imply negligence. The company found that most claims in the category were related to known risks that were often disclosed to the patient prior to the procedure. An undisclosed "small" portion were due to substandard care.
7. Patient behavior accounted for 29 percent of patient injuries. Patients who were dissatisfied with the care and sought other providers often eliminated the original physician's opportunity to address concerns or the unsatisfactory surgical outcomes through follow-up care.
8. The Doctors Company claims that the findings note the importance of helping patients understand the information provided during the informed consent process. The study also may help highlight the importance of engaging the patient and family when a complication occurs to show empathy and explain what caused the undesirable results.
9. "Although the patient may continue to be unhappy with the outcome of care, a patient who feels engaged in his or her care and treatment may be less inclined to attribute the outcome to negligence or to bring a liability claim against the physician," according to the study.
10. The study lists several strategies an orthopedist could use to help avoid some of the risk associated with care. Becker's Spine will have a story on some of the Doctors Company's findings tomorrow.
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