Reducing Complexity and Facilitating Collaboration Following a Harm Event

July 10, 2023
An unintended outcome following a routine procedure

An elderly patient underwent a routine upper gastrointestinal (UGI) procedure after coming to the emergency department (ED) with a 10-day history of problems swallowing and feeling like food was stuck in his esophagus. The physician dilated the man’s esophagus and noted a tortuous esophagus, benign-appearing esophageal stenosis, erythematous mucosa of the stomach, an ulcer and duodenal erosion. The physician obtained biopsies and discharged the man home with a prescription for Omeprazole.

One week later, the biopsy results returned showing an infection. The physician instructed a clinic team member to call the patient and antibiotics were prescribed. The patient told the clinic team member that he was having epigastric pain that he thought was a result of the biopsies. After discussing the patient’s complaints with the physician, the patient was instructed to go to the ED. He did not go to the ED.

Three weeks after this procedure, the physician was blindsided by the news that the patient had taken a turn for the worse and had presented to an ED complaining of severe epigastric pain. The ED physician ordered a chest and abdominal CT that detected a retained surgical item and perforation of the distal esophagus. The patient was referred to a surgeon who performed a repair of the esophagus and removed a 5 cm (about 1.97 in) piece of guidewire used in the procedure. After several weeks of hospitalization, the patient was discharged home and went through additional outpatient therapy.

Early reporting

The physician involved noted she was surprised to learn of the patient’s condition because, “it was not on my radar that this would be anything other than a routine procedure. While we are aware of and share known risks with our patients prior to conducting any procedure, I was devastated that something rare like this had happened to my patient and immediately wanted to know what happened.” The physician then reported the adverse outcome to Constellation, and our claim team sprang into action.

Decoding the complexity of an incident

After receiving the report of the event, the first step Constellation took was to analyze the care provided. Constellation uncovered several factors that made this incident more complex:

  • The involvement of several different health care professionals and organizations
  • Constellation insured only the physician who performed the UGI
  • Unclear responsibility of who should have noticed the broken guidewire
  • Lack of follow up—the patient failed to comply with prescribed post-procedure recommendations

After our initial analysis of the case, Constellation arranged for a medical expert review of care and began to map the chain of events that led to the retained item and perforation of the esophagus. The medical expert review determined that there were no issues with the UGI procedure. Our experts assessed this as an extremely rare, unexpected risk and complication of the procedure.

Our insured physician recalled working through the medical expert review of the care provided. “There are a lot of layers to what happened and, ultimately, it was determined to be primarily a procedural problem where a process change was needed.” Our insured physician, the hospital and our team built a collaborative working relationship to tackle next steps. Constellation kept our insured physician apprised of each step of the expert review and facilitated communication between all the involved parties. The hospital initiated a procedural change to help reduce the risk of a similar harm event in the future. Constellation contacted the patient and shared the findings from the expert review that supported our insured physician’s care.

Fast resolution so all involved can move forward

When the patient secured counsel the following year, Constellation was ready to respond. Our insured physician shared how early intervention resulted in a fast, collaborative resolution. “I was happy that Constellation was able to get involved early on and bring all sides together. This incident had the potential to drag out for years, but Constellation helped resolve it with a resolution that left everyone feeling comfortable. When plaintiff counsel entered the picture, we were all aligned and united when we came to the table with the patient. Constellation made that happen, which was a huge help.” 

Despite the complexity of this case, Constellation reached a resolution with the patient in weeks. By sharing a clear picture of the events leading up to the outcome, alignment on all sides, and fair settlement figures, all parties were able to move on as quickly as possible. And, by leveraging early intervention which quickly led to the medical expert review, our team was able to avoid a lawsuit and trial, which benefited all involved:

• The patient was able to voice their experience and receive settlement funds immediately
• Our insured physician was able to close the chapter of this difficult harm event and continue providing high-quality care to her patients
• The organizations involved were able to save time and money and enact procedural improvements for future care

Our insured physician recounted, “If you do thousands of procedures a year, there will be unanticipated events. I’m glad to know I have support in those situations and that they don’t have to be career-ending. It was incredibly stressful and emotionally challenging, but we learned from it and now have better safety measures in place.”

The benefits of early reporting to Constellation

We are prepared and ready to support our client care teams, clinicians and health care organizations immediately following a harm event. We encourage customers to contact us as soon as possible when things don’t go as planned, so we know to offer our early intervention services.

 At Constellation, we’re creating a better way forward after harm events—a way that can preserve relationships, promote communication, and improve everyone’s experience. Our early intervention program champions this better way forward.

Constellation’s experience shows that early intervention shortens the lifecycle of a case by over 18 months when indemnity is paid. These shorter case lifecycles alleviate clinician stress and anxiety and lessen care team disruptions. Early intervention after a harm event can help patients, senior living residents, clinicians and care teams heal, a process that takes many forms.

Our early intervention program provides healing benefits for care teams and organizations because we truly believe that what’s good for care teams is good for business. 

If your organization experiences a patient harm event, please report the event as soon as possible to Constellation.

  • Incident reporting takes two minutes or less (known form content prepopulates for MyAccount users)
  • Submitting incidents in MyAccount immediately assigns your submission to a consultant (average response time is 24-hours or less!)
  • New claim casefile status tracker allows you to check on the status of your casefile at any time

To learn more about Constellation’s early intervention program and to assess your ability to respond effectively to a harm event like this one, sign in to to access the HEAL Prepare Toolkit and take the HEAL Assessment.

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