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American Journal of Medical Quality
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Commentary: Exploiting the Overlap: Using Utilization Management to Reduce Medical Malpractice

Sherrie Dulworth, RN, CPHRM

CPHRM, Milliman USA, 1 Pennsylvania Plaza, 38th Floor, New York, NY 10119 sherrie.dulworth{at}milliman.com

This report presents a practical way in which hospitals can reduce medical malpractice exposure that is related to omissions and delays in care. We illustrate our approach using the results of a risk/medical management study performed at an acute-care hospital. Traditional risk management (RM) often focuses retrospectively on adverse events and may miss opportunities to prevent errors related to omissions and delays in care. Close-to-realtime utilization management (UM) activity offers ready potential to improve quality and reduce medical malpractice-but only if UM can work synergistically with RM. It is our conclusion that hospitals can implement systematic processes to identify and intervene in patterns of omissions and delays and improve the communication and synergy among stakeholders and thereby improve patient safety and reduce their medical malpractice risks.

Key Words: Delays • hospitals • malpractice • omissions • patient safety • risk • utilization

American Journal of Medical Quality, Vol. 18, No. 3, 128-132 (2003)
DOI: 10.1177/106286060301800307
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