Commentary: Exploiting the overlap: using utilization management to reduce medical malpractice

Area of Science:

• Healthcare Management
• Patient Safety
• Medical Malpractice Prevention

Background:

• Traditional risk management (RM) often focuses retrospectively on adverse events.
• Existing RM strategies may overlook opportunities to prevent errors from care omissions and delays.
• Utilization management (UM) offers potential for quality improvement and malpractice reduction when integrated with RM.

Purpose of the Study:

• To present a practical approach for hospitals to reduce medical malpractice exposure related to care omissions and delays.
• To illustrate this approach using a risk/medical management study in an acute-care hospital setting.

Main Methods:

• Conducted a risk/medical management study at an acute-care hospital.
• Focused on close-to-real-time utilization management (UM) activities.
• Emphasized synergistic integration of UM and RM processes.

Main Results:

• Identified patterns of omissions and delays in patient care.
• Demonstrated the potential for UM to improve quality when working with RM.
• Showcased improved communication and synergy among healthcare stakeholders.

Conclusions:

• Hospitals can implement systematic processes to identify and intervene in care omissions and delays.
• Integrating UM and RM enhances patient safety and reduces medical malpractice risks.
• Improved stakeholder communication and synergy are key to mitigating malpractice exposure.