# Analysis of Closed Claims in Cardiovascular Medicine: Importance of Nonclinical Factors

## TL;DR

This study examines factors behind medical liability claims in cardiovascular medicine, showing nonclinical issues like communication and documentation are as important as clinical errors.

## Contribution

The study highlights the equal importance of nonclinical factors in medical liability claims, offering actionable insights for improving patient care and reducing conflicts.

## Key findings

- Nonclinical factors, such as communication and documentation, were more frequent than clinical factors in liability claims.
- Communication between providers and patients was the most common nonclinical factor in claims.
- Payment-related claims showed a higher frequency of nonclinical factors compared to non-payment claims.

## Abstract

Medical professional liability claims are a marker of conflict between a patient and a health care provider.

The purpose of this study was to evaluate the contributing factors (CFs) associated with medical professional liability claims.

Seven hundred sixty-four cardiovascular-related closed claims with 1,945 CFs were identified from a large insurer (The Doctor’s Company) from 2010 to 2023.

Three clinical CFs: technical performance (329; 43% of claims), patient assessment (242; 32%), and management/selection of therapy (216; 28%) were the most frequently cited CFs. Patient factors, mainly due to nonadherence to medications or instructions, were identified in 171 claims (22%). Nonclinical CFs (987) were more frequent than clinical CFs (787) and patient factors (patient: 171). Nonclinical CFs were very diverse but the most frequent were communication between providers and patient (20%), communication among providers (16%), insufficient documentation (11%), and off-shift/weekend hours (10%). Payment was less common in claims with technical performance or patient factor CFs and more common in claims with patient assessment, selection/management of therapy, and in the 4 most frequent nonclinical CFs. Nonclinical CFs were more commonly observed in claims with payment (1.1/claim) when compared to claims without (0.64/claim). No differences among the different cardiovascular subspecialties were identified. Closed claims were identified in 3% of covered cardiovascular providers over the last reliable portion of the study period.

Clinical and nonclinical CFs are equally important for malpractice claims. While focusing on clinical quality is important, implementing strategies that also account for nonclinical issues, with a particular focus on communication, documentation, and off-shift/weekend coverage could have significant benefits.