Medico-legal risk in the emergency department

The landscape of the medico-legal risk in emergency medicine in Canada is unknown. The objective of this study was to describe and analyze factors associated with medico-legal risk in cases in the emergency department (ED).

We conducted a descriptive analysis of closed medico-legal cases (hospital complaints, regulatory authority (i.e., College) complaints, and civil-legal actions) involving physicians practicing primarily emergency medicine in Canadian EDs. We used data from closed cases involving the Canadian Medical Protective Association from January 2018 until December 2022. We abstracted descriptive factors of the cases and used a framework for contributing factors classification.

From 2018 until 2022, 37,046 cases were closed and 1,892 involved physicians practicing emergency medicine for which there was medico-legal information available for analysis. In all, 54% (1,019) were College complaints, 27% (516) were legal civil actions, and 19% (357) were hospital complaints. Out of these, 1,165 (62%) were subject to peer-expert criticism. More than half of the complaints (52%) resulted in an unfavorable medico-legal outcome for the physician. Analysis of the 1,165 cases with peer-expert criticism identified the most common factors contributing to medico-legal risk included clinical decision-making (64%), situational awareness (44%), and issues with provider's documentation (42%).

The most common diagnoses associated with medico-legal risk were injuries, infections, and disorders of the circulatory system. The three most common contributing factors were related to clinical decision-making, situational awareness, and issues with documentation.