Reducing the Risks of Gastrointestinal Emergencies

Gastrointestinal emergencies account for 19% of medical malpractice claims among hospitalists insured by MagMutual. Considering gastrointestinal emergencies are among the most common reasons to be admitted to an intensive care unit, and critically ill patients admitted to the ICU for other reasons are at increased risk of developing GI complications during their hospitalization, it’s not a surprise this condition is a top driver of risk.¹

To help hospitalists reduce the number of claims related to gastrointestinal emergencies, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of these types of claims and developed strategies to improve patient outcomes. 

Top Risks

Top Strategies for Reduction

Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

Clinical strategies

• It is important to examine and palpate the upper abdomen in patients presenting with chest pain. Acute cholecystitis or pancreatitis may have chest pain as the presenting symptom. For patients with lower abdominal pain and an unclear diagnosis, a GU exam may be performed, including a testicular and inguinal exam for males and a pelvic exam for females. Consider a specialist consultation, like gynecology, to evaluate for reasonable differential considerations outside of your scope of practice. If the probability of this consideration is low, referencing a reassuring emergency department examination may be adequate.
• In the setting of sepsis, evaluate for an intra-abdominal source as a possible etiology. Do not solely rely on a positive urinalysis as indicative of a urinary tract infection if there is significant abdominal tenderness or the diagnosis is not clinically consistent. Keep in mind that an inflammatory mass, such as appendicitis, pressing against a ureter can result in pyuria.
• Be aggressive with early fluid resuscitation in patients with acute pancreatitis. Studies have shown that this can decrease morbidity and mortality. Additionally, it is important to monitor patients for persistent hemoconcentration at 24 hours, which has been associated with the development of necrotizing pancreatitis and a higher mortality rate.

Operational strategies

• It is crucial to recognize the conditions that require surgical or interventional radiology consultation in addition to antibiotics in the setting of sepsis with an intra-abdominal source. These conditions include sepsis related to bowel perforation, intra-abdominal abscess, infected ureteral calculus and others that necessitate emergency consultation. It is important to directly communicate with the specialist and to document the expediency of the consult.
• When deciding not to order imaging for a patient with abdominal or GI complaints, it is important to document the reasoning for this decision and discuss it with the patient. However, it is important to note that no radiologic study is completely accurate, so in cases of unexplained and concerning abdominal pain, it is necessary to have a low threshold for extending observation and/or consulting a surgeon. Accurate documentation of a thorough abdominal examination, assessment of bowel function and discussions with consultants are important to guide clinical decision-making.
• It is important to respond to calls for help from nursing with an in-person evaluation, especially when involving abnormal vital signs or repeated requests for analgesia for abdominal pain.

Other Top Risks

Gastrointestinal emergencies are among the most severe claims against hospitalists according to our data, but we’ve also identified several other drivers of loss based on claims frequency:

Risk Drivers by Top Cause

Risk Drivers by Frequency

Data Collection & Methodology

Data is based on MagMutual closed claims from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.

[1] https://pubmed.ncbi.nlm.nih.gov/36415066/