High percentage of radiology malpractice claims originate in emergency department

Nearly half of all radiology malpractice claims involve patients treated in the emergency department (ED), according to a new study published in the Journal of the American College of Radiology.

“Diagnostic errors are the primary source of liability risk in radiology,” wrote Jeffrey D. Robinson, MD, MBA, department of radiology at the University of Washington in Seattle, and colleagues. “Radiologists are in the midrange of subspecialists with respect to both the frequency of claims and the cost of settlements. Even so, the average radiologist is involved with the medicolegal system for a substantial portion of her career.”

The authors explored 149 imaging examinations from 18 states that were the subject of litigation. All cases occurred from 2012 to 2019. The data came from Cleareview, a Seattle-based platform for blind reviews of imaging examinations involved in litigation. Medicare data was also reviewed to track the proportion of examinations performed in the ED throughout the United States.

Overall, the place of service associated with 46% of the malpractice claims included in the study was the ED. While 38% of the claims involved outpatients, the other 17% involved inpatients.

“The odds of a claim arising from an ED examination was nearly 4-fold higher in the cohort of malpractice claims than the proportion of ED examinations in the Medicare cohort,” the authors wrote. “This raises the possibility that ED examinations are at higher risk of being the subject of a malpractice claim than inpatient and outpatient examinations.”

Why, exactly, do so many more malpractice claims involve ED patients? According to Robinson et al., “several potential factors contribute to this imbalance in ED examinations between the malpractice claims and Medicare cohorts.” One such factor, the authors wrote, was that the Cleareview database only includes cases that were “deemed suitable” for a blind review. Issues related to “communications failures, procedural complications or consent complaints,” for instance, don’t always need to be submitted for a blind review.

Ultimately, however, the authors feel that their findings “support the hypothesis that ED examinations are at a higher risk of malpractice claims.” This could be because ED studies are distributed to a wide range of specialists, the researchers wrote, or because “the pace and coverage hours demanded by emergency radiology can lead to an increase in diagnostic errors.”

Another factor, according to the researchers, is that radiologists reading ED studies may not necessarily have the exact amount of subspecialized training needed to identify a crucial detail. 

“For example, traumatic injuries often cut across organ systems, so in a given polytrauma victim, findings that may be clear to a musculoskeletal subspecialist may be obscure to a body imager, or vice versa," the authors wrote. "A neuroradiologist may have difficulty assessing the activity of a flare-up of inflammatory bowel disease. A chest radiologist may not be familiar with the current guidelines around the reporting of nonviable pregnancy.”