• David M Dudzinski, Sandeep S Mangalmurti, and William J Oetgen.
• Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, New York. Electronic address: ddudzinski@partners.org.
• J Am Soc Echocardiogr. 2019 Mar 1; 32 (3): 359-364.

BackgroundMedical claim data offer the possibility to improve patient care and mitigate liability. Although published analyses exist in cardiology, no information is available for transesophageal echocardiography (TEE). In this study, the authors reviewed medical claims involving TEE to identify potential risk management concerns so that these lessons could be used to improve the safety and quality of transesophageal echocardiographic practice.MethodsThe authors reviewed anonymized clinical and claims data from all closed claims from 2008 to 2013 for a single national physician liability insurer.ResultsThere were no claims involving transthoracic echocardiography and eight involving TEE. Three claims involved esophageal perforation, a known risk of TEE. Two claims involved quadriplegia allegedly due to neck manipulation in the setting of a cervical spinal abscess that should have been suspected. Three claims involved the cardiologist's failure to diagnose endocarditis, with allegations that the cardiologist did not perform TEE in an appropriate time frame to avoid major morbidity and mortality from endocarditis.ConclusionsLiability claims associated with TEE involve failure to order and perform TEE in an appropriate clinical scenario and in a timely manner; failure to properly document medical decision making; failure to inform patients regarding risks of TEE; failure to properly monitor the patient before, during, and after TEE; and technical difficulties in performing the procedure. Cardiologists should recognize guideline-based indications when TEE is needed and be mindful of the complication rates of this procedure. When screening a patient for TEE, consider expert input that may reduce the risks of TEE (e.g., a spine specialist for a neck injury, a gastroenterologist for esophageal comorbidity). Informed consent and medical record documentation should be practiced as a vehicle to inform patients of these risks and chronicle decision-making processes.Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

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