Pediatricians are not free from malpractice risks. In fact, one in five is sued over the course of their career. Although pediatricians are not accused of malpractice as frequently as other specialists, when they are sued the stakes are high. 

In a perfect world, pediatricians could practice quality medicine and never worry about being sued. Unfortunately, providing high quality care is no guarantee against malpractice claims.      

Risk management decreases medical liability risk. It is a proactive, systematic process to help identify, evaluate, and address problems that may injure patients, lead to malpractice claims, and cause financial loss to health care entities. Effective risk prevention depends on the reliable recognition of risk exposure, determination of its causes, implementation of corrective actions, and continual monitoring of risk indicators to determine if risk exposure improves.  

The following characteristics make risk management more challenging in pediatric settings:  

  • Relative rarity of many pediatric illnesses 
  • Limited capacity for communication and cooperation in young children 
  • High levels of dependency on others (e.g., parental observation and assessment of problem) 
  • Changes in patient (e.g., weight, height, physiologic and developmental maturation) 
  • High-volume specialty (many patients, many visits, many telephone calls, and the emergence of telehealth care).    

Several strategies a practice might consider include:

  • Evaluate past adverse events and identify specific areas where risk can be mitigated.  
  • Proactively assess current processes and patient contacts.
  • Ensure risk management is a continuous process with appropriate adjustments and fine tuning as needed.
  • Include both operational and clinical activities in risk management assessments because liability may originate in either area.
  • Develop risk reduction strategies that are appropriate for the practice.
  • Make certain that the risk management program is documented in written policies and procedures.

Risk Identification Methods 

Effective risk management begins with a system for identifying the specific events likely to result in increased medical liability risk. The following are some common methods.   

Legal Actions 

The easiest and most obvious way to identify risk is to assess what ordinary activities of pediatric practices result in lawsuits.   

Patient/Family Complaints and Satisfaction Surveys 

Reviewing patient/family complaints is a good way to detect cases involving communication failures or poor quality health care. Many organizations have formalized mechanisms for handling patient/family complaints. Often, descriptive statistics of patient/family complaints are generated routinely, such as monthly compilation of all complaints by type, clinical/administrative area, and involved staff. Creating a culture of exploration into the reason for the complaint can determine patterns with systems or specific clinicians that can be addressed. A focused review of complaints that suggest communication problems or poor quality can be helpful when looking for patterns that might increase risk. Occasional random patient/family satisfaction surveys can also reveal areas of strength and risk.  

Billing Disputes  

A review of billing disputes is another method of identifying risk and quality deficiencies. Families often refuse to pay bills because they believe that the care received was substandard and therefore not deserving of payment. Some families also make accusations of poor quality care simply to justify their refusal to pay for care. This compromises the effectiveness of billing disputes as a risk identification tool. Consequently, detailed clinical review should probably be reserved for cases involving large sums of money or significant accusations of substandard quality.   

Occurrence (Incident) Reporting 

Rather than wait for a legal action, record request, complaint, or billing dispute to initiate the process of risk identification, most practices ask staff to notify the managing partner should an untoward or unusual incident occur. Hospitals or larger practices have Risk Management Departments and skilled professionals who should be immediately contacted for guidance. If you are a pediatrician in an independent practice, it would be prudent to notify your medical liability insurer who may open a file regarding the incident. Often a special form, commonly referred to as an incident report, patient safety report, or variance report, is provided for this purpose. The form indicates the minimum specific information that must be provided about the incident. Although the information contained in the report may be protected from legal discovery by state law, some institutions request that the reports of patient harm resulting from medical misdiagnoses, therapies, and procedures be reported verbally rather than in writing. If an incident report is filed, it should not be referenced in the medical record, or it might be deemed discoverable.  

Occurrence Screening  

Because occurrence reporting can be unreliable, some practices identify groups of cases (based on specific criteria) for screening review called occurrence screening. These can be generic screening events that have been identified as areas of concern (e.g., unanticipated return visits for the same problem within a specified time period, emergency department encounters shortly after an office visit.). The mere occurrence of a generic event does not imply the presence of risk or a quality deficiency. Rather, the occurrence event indicator is meant to trigger a careful review to ascertain whether a quality problem or risk exists.   

Random Medical Record Review  

A common practice in the early years of risk management, random medical record reviews involved an unfocused peer review of randomly selected medical records as a quality assurance activity. Random medical record review is less commonly used today because the low yield of positive findings making it cost-inefficient. However, a program of random medical record reviews by physicians can be beneficial in educating them about the wide variety of practice styles and approaches present . Over time, this may lead to group consensus on the identification of less than optimal behavior or poor documentation. Some medical liability insurers offer onsite evaluations of practice for risk reduction purposes, which may include random chart reviews. Frequently these evaluations result in concrete suggestions for improving risk management.  

Closed Malpractice Claims 

One of the best ways to identify potential risks is to review closed malpractice claims and articles on malpractice trends.    

It is well worth your time and money to invest in the above risk management strategies to protect your office and your career from malpractice claims.  

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American Academy of Pediatrics