• Brian Ferguson, Justin Geralds, Jessica Petrey, and Martin Huecker.
• Department of Emergency Medicine, University of Louisville, Louisville, Kentucky.
• J Emerg Med. 2018 Nov 1; 55 (5): 659-665.

BackgroundMalpractice in emergency medicine is of high concern for medical providers, the fear of which continues to drive decision-making. The body of evidence evaluating risk specific to emergency physicians is disjointed, and thus it remains difficult to derive cohesive themes and strategies for risk minimization.ObjectiveThis review evaluates the state of malpractice in emergency medicine and summarizes a concise approach for the emergency physician to minimize risk.DiscussionThe environment of the emergency department (ED) represents moderate overall malpractice risk and yields a heavy burden in finance and time. Key areas of relatively high litigation occurrence include missed acute myocardial infarction, missed fractures/foreign bodies, abdominal pain/appendicitis, wounds, intracranial bleeding, aortic aneurysm, and pediatric meningitis. Mitigation of risk is best accomplished through constructive communication, intelligent documentation, utilization of clinical practice guidelines and generalizable diagnoses, careful management of discharge against medical advice, and establishing follow-up for diagnostic studies ordered while in the ED (especially x-ray studies). Communication breakdown seems to be more predictive of malpractice litigation than injury experienced.ConclusionsThere are consistent diagnoses that are associated with increased litigation incidence. A combination of mitigation approaches may assist providers in mitigation of malpractice risk.Copyright © 2018 Elsevier Inc. All rights reserved.

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