15 Strategies for Tackling the Top Malpractice Allegation in Gynecology

MedPro Group data show that allegations related to surgical treatment represent the largest claims category for gynecology providers (73 percent of all gynecology claims closed between 2005 and 2014). Surgical treatment allegations also account for almost two-thirds of all dollars paid for expense and indemnity costs in gynecology claims.

Within these surgical treatment allegations, the top issue cited is improper performance of surgery, which accounts for 8 out of 10 surgical treatment claims. These allegations most often are the result of a known complication of a procedure (e.g., a bowel or bladder laceration); however, these situations often are complicated by a failure to recognize and act upon patients’ changing postoperative clinical conditions.

Other issues cited include improper management of surgical patients and retained foreign bodies. Improper management covers preoperative, intraoperative, and postoperative situations, such as inadequate monitoring of vital signs; improper surgical skin site preparation; and delayed recognition of complications following discharge. Although relatively few claims are associated with retained foreign bodies, these allegations are still a concern, and most often they are noted in abdominal hysterectomy cases.

The following list offers strategies to help gynecology providers manage surgical treatment risks:

1. Ensure your organization adheres to credentialing and recredentialing processes through focused professional practice evaluation and ongoing practice performance evaluation.
2. Develop a peer review process and conduct peer review activities to improve performance/quality. Routinely evaluate quality indicators and implement performance improvement plans to address safety risks and improve quality of care.
3. Continually enhance your technical surgical skills and communication skills through continuing medical education and training.
4. Conduct thorough informed consent discussions with patients, including a review of risks, benefits, and alternative treatments. Use layman’s terms during these discussions, and ask patients to repeat back their understanding of their treatment plans.
5. Document the informed consent process and make sure any signed informed consent forms are included in patients’ records.
6. Verify that each patient’s record contains thorough and appropriate information, such as history and physical, current medications, nonpharmacological interventions, allergies, pain assessment outcomes, test results, consults/referrals, treatment goals, and preoperative screening results.
7. Ensure that all appropriate health information for each patient is available prior to commencement of a procedure.
8. Inventory and verify necessary equipment and supplies before each procedure begins.
9. Ensure infection prevention and control best practices (e.g., those related to hand hygiene, safe injections, skin preparation, instrument sterilization, environmental cleaning, etc.) are used to maintain the sterile field.
10. Use standardized patient safety precautions during each procedure, such as timeout protocols, proper patient positioning, surgical item counts, etc.
11. Make sure patients are appropriately monitored during and following procedures (e.g., vital signs, airway, pain, etc.).
12. Maintain a consistent postoperative discharge assessment process, and carefully consider repeated patient complaints or concerns when making clinical decisions about patient care and diagnostic testing.
13. Provide patients/caregivers with written and verbal instructions related to their treatment plans and follow-up care.
14. Complete a detailed operative report on the day of each procedure.
15. Document all instances of patient noncompliance as they occur, as well as any education provided to the patient or family/caregiver.

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