Reducing the Risks Associated with Cerebrovascular Accidents

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Cerebrovascular accidents (CVAs) account for 19% of medical malpractice claims among neurologists insured by MagMutual. It is estimated that about one in ten cases of strokes are regularly misdiagnosed or diagnosed late,^[1] which can drastically affect a patient's chance of recovery, and also explains why CVAs are a top driver of risk for physicians.

To help neurologists reduce the occurrence of claims related to cerebrovascular accidents, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of claims related to this issue and developed strategies to improve patient outcomes.

Top Risks

Top Strategies for Reduction

Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

Clinical strategies

• Litigation related to a "failure to treat" is much more common than litigation related to a complication associated with the treatment of acute ischemic stroke. Consider stroke alert activation and urgent neurological consultation (in person or via telemedicine services) for all suspected stroke patients presenting within 24 hours of last known well.
• Given the time-sensitive nature of acute stroke treatment, ensure the timely evaluation, transfer and treatment for any patient with acute ischemic stroke requiring higher level of care or consideration of advanced therapy. Consider large vessel occlusion as a diagnosis for potential endovascular thrombectomy for all stroke patients presenting within 24 hours of last known well, in addition to, or if ineligible for, IV thrombolytic therapy (e.g., active anticoagulation use). This approach could result in an improved outcome.
• Consider acute ischemic stroke and thrombolytic therapy for all patients aged 18 or older without absolute contraindications.
• Maintain appropriate level of suspicion for stroke following procedures, particularly carotid endarterectomy and obstetric childbirth.

Operational strategies

• Utilize comprehensive stroke order sets for all patients receiving IV thrombolytics for acute ischemic stroke to ensure adherence with appropriate post-thrombolytic monitoring and care. Immediately after phone consultations, document in the EHR the elements of the conversation, timing and any diagnostic or therapeutic recommendations.
• Identify and eliminate inefficiencies in practice guidelines for acute stroke therapy.
• Document reasoning and justification for not giving a treatment, like thrombolytics, including any and all contraindications.

Other Top Risks

Although CVAs are associated with a significant number of claims among neurologists according to our data, we’ve identified several other drivers of loss based on claims frequency:

Risk Drivers by Top Cause

Risk Drivers by Frequency

[1] https://www.penningtonslaw.com/news-publications/latest-news/2023/the-consequences-of-a-delayed-or-missed-diagnosis-of-a-stroke 

Data Collection & Methodology

Data is based on MagMutual closed claims from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.