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The "NUTS" statistic: Applying an EBM disease model to defensive medicine.
Journal Title
Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management
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Publication Date
2021-09-15
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Publication Volume
41
Publication Issue
3
Publication Begin
9
Publication End
12
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Abstract
Physicians believe that malpractice concerns result in unnecessary testing, and many emergency physicians state that avoiding malpractice is a contributing factor to ordering medically unnecessary tests. Unfortunately, defensive medicine does not come without possible harm to patients who may be subject to non-beneficial, downstream testing, procedures, and hospitalizations. We submit a novel statistic, "NUTS" or "Number of Unnecessary Tests to avoid one Suit. " We calculated a NUTS of 4737 for troponin testing in ED patients with suspected myocardial infarction, meaning a clinician will need to order 4737 medically unnecessary troponin tests to avoid one missed myocardial infarction lawsuit. The NUTS framework offers us an evidence-based lens to examine defensive medicine less superstitiously and more based on currently available data.
Citation
Allen R, Cai AG, Tepler P, deSouza IS. The "NUTS" statistic: Applying an EBM disease model to defensive medicine. J Healthc Risk Manag. 2022 Jan;41(3):9-12. doi: 10.1002/jhrm.21486. Epub 2021 Sep 15. PMID: 34528329.