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Who Gets Sued in EM – NP, PA, Attending, or Resident?

October 13, 2023

Written by Christopher Thom

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In a retrospective analysis of 5,854 emergency department malpractice cases from over 550 US hospitals, 193 (3.3%) involved an NP, 513 (8.8%) involved a PA, 535 (9.1%) involved a trainee, and 4,568 (78.0%) were attending only.

Supervision and training are critical variables in malpractice cases
The proportion of malpractice cases in Emergency Medicine that involve a resident physician, NP, or PA remains poorly understood and is likely to evolve. Cases that do involve an advanced practice provider (APP; NP or PA) or resident physician may have different characteristics and result in different indemnity payment amounts.

This was a retrospective review from 2010 to 2019 of the Candello database, which is inclusive of approximately 33% of the malpractice cases in the US. The database sorts cases via severity, contributing factors, and financial cost. The analysis found that there was a higher proportion of medium severity cases when an APP was involved (NP 48.7%, PA 45.8%, no extender 36.8%) and a lower proportion of high severity cases (NP 45.6%, PA 48.3%, no extender 50.2%), with significant p values across severity levels. Clinical judgment, documentation, and supervision were more frequent contributing factors in APP cases as compared to no extender cases. Average indemnity payment amount was highest in resident physician cases, followed by APP cases, and then lowest for attending only cases.

How will this change my practice?
As one might expect, higher severity cases are more common in the attending-only cohort. Clinical judgment is more frequently cited as a contributing factor for APP involved cases, as is supervision. The attending physician should keep supervision practices in mind when working alongside APPs and be aware of these common contributing factors in APP related cases. Resident physicians were listed in 9.1% of cases, and effective supervision for technical skill related activities should be emphasized with these trainees.

Characterizing malpractice cases involving emergency department advanced practice providers, physicians in training, and attending physicians [published online ahead of print, 2023 Sep 8]. Acad Emerg Med. 2023;10.1111/acem.14800.

What are your thoughts?