Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia. Ann Emerg Med 2005 Dec;46(6):525-33
Date
11/26/2005Pubmed ID
16308068Pubmed Central ID
PMC7539660DOI
10.1016/j.annemergmed.2005.04.016Scopus ID
2-s2.0-27944477742 (requires institutional sign-in at Scopus site) 199 CitationsAbstract
STUDY OBJECTIVE: We evaluate the association between emergency physicians' fear of malpractice and the triage and evaluation patterns of patients with symptoms suggestive of acute coronary syndrome.
METHODS: We surveyed 33 emergency physicians of 2 university hospitals during the preintervention phase of an implementation trial of the Agency for Health Care Policy and Research Unstable Angina guideline in 1,134 study patients. The survey included a 6-item instrument that addressed concerns about malpractice and a measure of general risk aversion. We used hierarchical logistic regression to model emergency department (ED) triage decisions and diagnostic testing as a function of fear of malpractice, with adjustment for patient characteristics, Agency for Health Care Policy and Research guideline risk group, study site, and clustering by emergency physician.
RESULTS: Overall, emergency physicians in the upper tertile of malpractice fear were less likely to discharge low-risk patients compared with emergency physicians in the lower tertile (adjusted odds ratio [OR] 0.34; 95% confidence interval [CI] 0.12 to 0.99; P=.05). Patients treated by emergency physicians in this group were also more likely to be admitted to an ICU or telemetry bed (adjusted OR 1.7; 95% CI 1.2 to 2.4). In addition, emergency physicians in the upper tertile of malpractice fear were more likely to order chest radiography, as well as cardiac troponin. Malpractice fear accounted for a similar amount of variance after controlling for emergency physicians' risk aversion.
CONCLUSION: Malpractice fear accounts for significant variability in ED decisionmaking and is associated with increased hospitalization of low-risk patients and increased use of diagnostic tests.
Author List
Katz DA, Williams GC, Brown RL, Aufderheide TP, Bogner M, Rahko PS, Selker HPAuthor
Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAngina, Unstable
Attitude of Health Personnel
Chest Pain
Defensive Medicine
Diagnosis, Differential
Emergency Medicine
Fear
Female
Health Care Surveys
Humans
Logistic Models
Male
Models, Theoretical
Multivariate Analysis
Myocardial Ischemia
Odds Ratio
Professional Practice
Risk Assessment
Risk-Taking
Triage
United States