Data Dive Study: ‘Leveraging Data: A Focused Review of Advanced Practice Professionals’

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Advanced practice professionals provide an added benefit to any medical practice. Also, they are generally a low medical liability risk. Their employment allows busy physicians to focus on more complicated high-risk patients.  For example, APPs who are nurse practitioners and physician assistants have more time to spend with patients and their families building rapport and increasing their overall satisfaction with care. These APPs enable patients to experience greater access to healthcare and reduced office wait times.

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However, due to the sheer volume – not professional capabilities – of advance practice professionals in our members’ offices, CAP anticipates an increased vulnerability to medical liability lawsuits. This data study of CAP Closed Claims concerning APPs allows members to understand common areas of medical liability risk; to identify contributing factors, such as poor communication and lack of supervision, that may negatively affect patient outcomes; and to pinpoint systems issues and proactively manage risk by implementing our recommended risk management strategies.

Over the last several years, the concept of patient safety in the office setting has gained greater focus. As we go forward with our data deep dive studies, lessons can be learned in the outpatient setting and important steps can be incorporated into your office safety plan to prevent events instead of relying on retrospective learnings from medical malpractice claims data.  In this data study, we provide a case study, a list of the top five allegations against APPs, the most common risk management issues identified, emerging trends, and risk management strategies to improve patient outcomes.

CAP risk management staff evaluated 42 (n=42) closed claims for the six-year period of 2011 through 2016 involving APPs resulting in an indemnity payment. The average indemnity paid was $223,149 and, in most cases, was made on behalf of the supervising physician’s medical professional liability coverage (MPL). The study found the top five allegations against APPs were: Improper Management of Course of Treatment, Failure to Refer/Seek Consultation, Failure to Manage Pregnancy, Failure to Diagnose, and Improper Management of Medication Regime. When we looked at the contributing factors for these cases we found: lack of supervision, lack of clinical judgment, communication failure, and poor documentation. Actively addressing these contributory factors should be a goal for physicians and office managers. Interventions to reduce ineffective communication and lack of supervision are listed in the risk strategy section of the study. 

We hope you find the Risk Management and Patient Safety Data Dive periodical, “Leveraging Data: A Focused Review of Advanced Practice Professionals,” informative and useful to ensure that your APPs are qualified, competent, and knowledgeable.  It is our hope that this data study will provide physicians with information and insights that will encourage process improvement and change resulting in improved patient safety.

We encourage member physicians to review the CAP website and references provided on the back page of the study. CAP’s risk management and patient safety staff is available to discuss ways to implement the risk strategies listed and to assist with systems process improvement challenges.

Ann Whitehead is Vice President, Risk Management and Patient Safety for CAP. Questions or comments related to this article should be directed to The information in this publication should not be considered legal or medical advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.