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Trend analysis of emergency department malpractice claims in the Netherlands

a retrospective cohort analysis

Wansink, Luuka; Kuypers, Maybritt I.b; Boeije, Tomc; van den brand, Crispijn L.d; de Waal, Manone; Holkenborg, Jorisf; Ter Avest, Ewoudg,h

doi: 10.1097/MEJ.0000000000000572
Original article: PDF Only

Background Over the past two decades, several quality improvement projects have been implemented in emergency departments (EDs) in the Netherlands, one of these being the training and deployment of emergency physicians. In this study we aim to perform a trend analysis of ED quality of care in Dutch hospitals, as measured by the incidence of medical malpractice claims.

Patients and methods We performed a multicentre retrospective cohort study of malpractice claims in five Dutch EDs over the period 1998–2014. Incidence risk ratios were calculated to demonstrate any relation of specific quality improvement initiatives with the primary outcome, defined as the number of claims per 10 000 ED visits per year.

Results During the study period, the cumulative number of ED visits increased significantly from 99 145 in 1998 to 162 490 in 2014 (P<0.01). In total, 228 of 2 348 417 ED visits (0.97/10 000) resulted in a malpractice claim. At the same time, the yearly number of ED claims filed decreased with 0.07 (0.03–0.10) per 10 000 each year. The claim rate was higher in the period before emergency physicians were employed in the ED [1.18 (0.98–1.41) claims per 10 000 visits] compared with the period after they were employed [0.81 (0.67–0.97), incidence risk ratio 0.69 (0.53–0.89), P<0.01].

Conclusion Even though the number of ED visits increased significantly over the past two decades, the number of malpractice claims filed after an ED visit decreased. Various quality improvement initiatives, including the training and employment of emergency physicians, may have contributed to the observed decrease in claims.

aDepartment of Emergency Medicine, Onze Lieve Vrouwe Gasthuis

bDepartment of Emergency Medicine, Amsterdam University Medical Center, Amsterdam

cDepartment of Emergency Medicine, Westfriesgasthuis, Hoorn

dDepartment of Emergency Medicine, Haaglanden Medical Centre, The Hague

eDepartment of Emergency Medicine, Elisabeth-TweeSteden Hospital, Tilburg

fDepartment of Emergency Medicine, Rijnstate Hospital, Arnhem

gDepartment of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands

hKent, Surrey, Sussex Air Ambulance Trust, Redhill, UK

Correspondence to Luuk Wansink, MD, Department of Emergency Medicine, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM Amsterdam, The Netherlands Tel: +20 599 9111; fax: +31 20 599 2996; e-mail:

Received April 12, 2018

Accepted August 13, 2018

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