Lessons Learned From Medical Malpractice Claims Involving Critical Care Nurses

Medical malpractice data can be used to improve patient safety.

To describe the types of harm events involving nurses that lead to malpractice claims and to compare claims among intensive care units (ICUs), emergency departments, and operating rooms.

Malpractice claims closed between 2007 and 2016 were extracted from a national database. Claims with a nurse as the primary provider were identified and then compared by location of the harm event: ICU, emergency department, or operating room. Multivariable regression was used to determine predictors of claims payment.

Of 54 699 claims, 314 involved ICU nurses as the primary provider. The majority (59%) of claims involving ICU nurses resulted in death or permanent injury. The most common allegation of claims involving ICU nurses was failure to monitor (47%), which was higher than among claims against nurses in the emergency department (9%) or the operating room (4%) (P < .001). The most common diagnosis in claims involving ICU nurses was decubitus ulcers (26%). Despite equivalent numbers of defendants per claim, the median indemnity for paid claims involving ICU nurses was higher ($125 000) than that paid for claims originating in the emergency department ($56 799) or operating room ($43 910) (P < .001). In multivariable regression, 2 variables increased the risk of claim payment: ICU location (odds ratio, 1.79 [95% CI, 1.29-2.48]) and permanent injury (odds ratio, 1.50 [95% CI, 1.07-2.09]).

Malpractice claims involving ICU nurses were distinct from claims in comparably fast-paced settings. Focusing harm-prevention efforts in the ICU on skin integrity and monitoring of patients would most likely mitigate many highly severe harms involving ICU nurses, which would benefit both patients and nurses.