RESUMO
BACKGROUND: Inappropriate utilization of higher-level health facilities and ineffective management of referral processes in resource-limited settings are becoming increasingly a concern in health care management in developing countries. This is characterized by self-referral and frequent bypassing of the nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. On July 1, 2021, Kenyatta National Hospital (KNH) enforced the Kenya Health Sector Referral Implementation Guidelines, 2014, which required patients to receive approval from the KNH referral office and a formal referral letter to be admitted at KNH to reduce the number of walk-ins and allow KNH to function as a referral facility as envisioned by the Kenya 2010 Constitution and KNH legal statue of 1987. OBJECTIVE: To determine the effect of enforcing the national referral guidelines on patterns of orthopaedic admissions to the KNH. This was a pre-post intervention study. Data abstraction was done for 459 and 446 charts before and after the enforcement of the national referral guidelines, respectively. RESULTS: Enforcement of the national referral guidelines reduced the proportion of walk-in admissions from 54.9% to 45.1%, while the proportion of facility referrals increased from 46.6% to 53.4% (p = 0.013). The percentage of non-trauma orthopaedic admissions doubled from 12.0% to 22.4% (p<0.001). There was also an increase in admissions through the Outpatient Clinic and Corporate Outpatient Clinic. The proportion of emergency admissions declined, while that of elective admissions increased. The increase in elective cases was mainly driven by the increase in female admissions with active insurance cover, tertiary education, non-trauma-related conditions and older age groups. However, the use of official formal written referral letters did not change despite the enforcement of the national referral guidelines. CONCLUSION: The enforcement of the national referral guidelines reduced the proportion of walk-ins' admissions to KNH. While the enforcement of the national referral guidelines had no effect on the use of official formal written referral letters, it did limit access and utilization of inpatient orthopedic services for young male patients with no active insurance cover and in need of emergency orthopedic care.
Assuntos
Encaminhamento e Consulta , Humanos , Quênia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Criança , Adulto Jovem , Hospitalização/estatística & dados numéricos , Pré-Escolar , Ortopedia/legislação & jurisprudência , Idoso , Admissão do Paciente/estatística & dados numéricos , LactenteRESUMO
BackgroundThe amendment to the medical licensing regulations (ÄApprO) was decided at the federal level in the version of the "Master Plan for Medical Studies 2020" passed in 2017. In addition to the organizational effort involved in redesigning the curricular teaching, the expected costs associated with the implementation of the new licensing regulations due to the necessary additional time and, therefore, personnel expenditure are of particular importance. Taking into account the different forms of study and the 20% scope for study-design provided to the individual faculties, the process of transferring the teaching content to the new modules confronts us with an enormous organizational challenge.Significance of O&UDiseases of the musculoskeletal system are of particular medical, social and economic importance. Therefore, the training of future physicians in the field of orthopedics and traumatology must be taken into account. The visibility of the field of orthopedics and traumatology must not be lost with the introduction of the new medical licensing regulations (ÄApprO).ImplementationThe implementation of the new medical licensing regulations at German universities will be costly and necessitates an increased number of staff. However, there is a great opportunity to position orthopedics and traumatology as a "central player" in the modular, interdisciplinary and interprofessional course landscape. It is, therefore, important to take on concrete responsibility for the design of the new teaching programs and to bring in our specialist and interdisciplinary skills wherever sensible and possible.
Assuntos
Licenciamento em Medicina , Ortopedia , Humanos , Currículo/tendências , Previsões , Alemanha , Regulamentação Governamental , Licenciamento em Medicina/legislação & jurisprudência , Ortopedia/educação , Ortopedia/legislação & jurisprudênciaRESUMO
Healthcare is a highly regulated industry whose practitioners are responsible for adhering to laws, regulations, policies, and standards of care. When poor outcomes occur, a malpractice case can arise, thus beginning the litigation process. Because nurses are leaders in the delivery of care, they may become involved in legal claims. The purpose of this article is to provide information, as a foundation for nurses who are unfamiliar with navigating the litigation process in a legal claim, and to help nurses build confidence in the process. An overview of the litigation process, nursing licensure, and essential legal terms is provided. A case scenario is introduced that addresses the role of a nurse in an orthopaedic medical malpractice case.
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Enfermagem , Ortopedia , Humanos , Ortopedia/legislação & jurisprudênciaRESUMO
OBJECTIVE: This study aimed to investigate the malpractice claims experienced by orthopedic and traumatology physicians and to determine their effects on burnout, job satisfaction, and clinical practice. METHODS: A questionnaire survey was conducted on orthopedic and traumatology specialists between May 2019 and February 2020. Data collection was carried out via e-survey at "turk-ortopedi" mail group, which is an electronic communication network of orthopedic and traumatology physicians. For data collection, sociodemographic data forms were used including the general characteristics, working conditions, and the malpractice claim events along with the Maslach Burnout Inventory scale to evaluate burnout and the Minnesota Satisfaction Questionnaire to investigate job satisfaction. RESULTS: In total, 353 orthopedic and traumatology physicians (348 men, 5 women), including 37 professors, 41 associate professors, and 275 surgeons, completed the questionnaire. In total, 65.4% of the participants (231 physicians and 471 relevant dossiers) stated that they were currently facing a malpractice claim. Emotional burnout and hesitant behavior in medical practices were significantly higher among the physicians who had undergone an investigation/trial with the claim of malpractice (p<0.05), whereas intrinsic job satisfaction was significantly lower (p<0.05). It was determined that orthopedic and traumatology physicians dealing with arthroplasty, vertebral surgery, hand surgery, and foot/ankle surgeries had undergone significantly more trials (p<0.05). In the evaluation of the burnout levels and job satisfaction scores of the physicians according to the age, academic title, seniority, and institution, it was determined that burnout level decreased with age, those between the ages of 25 and 34 years were exhausted the most, and job satisfaction increased with age. It was also found that burnout level decreased and job satisfaction increased as the academic title became higher, and attending physicians were the most exhausted. Moreover, burnout level decreased as seniority increased, the most senior ones were the ones most exhausted, and job satisfaction increased with seniority. CONCLUSION: Evidence from this study has revealed that malpractice claims cause emotional burnout, low intrinsic job satisfaction, and a hesitant behavior in medical practice for the orthopedic and traumatology physicians. The concept of malpractice alone may result in unnecessary analyses/examinations for patients. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.
Assuntos
Imperícia , Ortopedia , Médicos/psicologia , Traumatologia , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Revisão da Utilização de Seguros , Satisfação no Emprego , Masculino , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Ortopedia/legislação & jurisprudência , Ortopedia/normas , Traumatologia/legislação & jurisprudência , Traumatologia/normas , TurquiaRESUMO
OBJECTIVE: This study aimed to determine the characteristics of instant messaging application (IMA) usage for clinical consultation among orthopedic residents in Turkey and to explore their experiences and opinions concerning potential legal problems. METHODS: A questionnaire titled "Instant messaging for consultation among orthopedic surgeons" consisting of 21 questions was applied to orthopedic surgery residents, and the results were analyzed. The questions were designed to obtain information on 4 categories: 1) demographics and professional experience, 2) attitudes on the use of cellular phones, 3) IMA usage for clinical consultation purposes, and 4) problems and comments on smartphone application usage for clinical consultation purposes. The participants who had no experience with a smartphone or IMA usage were excluded at the final analysis. RESULTS: A total of 860 orthopedic residents (849 males [98.7%]; mean age=28.6 years; age range=22-44 years) participated in the survey (participation rate: 97.3%). The distribution of residency years was as follows: 1st year, 27%; 2nd year, 21.4%; 3rd year, 18.4%; 4th year, 17.4%; and 5th year, 49.9%. The most frequently used IMAs were WhatsApp (99.3%), Facebook Messenger (14.8%), Viber (8%), and Tango (1.3%). The rate of IMA usage for consultation was 95.3%. The most common reasons to prefer IMAs for consultation were being "fast" and "easy," but only 26.3% of the residents reported that they prefer the use of IMAs because they find them "reliable." Moreover, 41.7% of the respondents reported that they had an experience of misdiagnosis owing to the use of IMAs; 81.2% of the participants used the personal information of the patients during the consultation; 57.6% of the respondents considered that legal problems may arise because of the use of IMAs during the consultation; and 51.4% believed that an electronic platform, solely for consultation purposes, is required. CONCLUSION: This survey has shown that it is necessary to make some legal regulations regarding the use of IMAs for consultation purposes and to develop applications only for medical consultation purposes. Most of the trainees make decisions using IMAs without a proper examination, putting the patients at the risk of misdiagnosis. Moreover, the confidentiality of the patient's personal information appears to be in danger when IMAs are used. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.
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Internato e Residência , Ortopedia , Encaminhamento e Consulta , Adulto , Erros de Diagnóstico/prevenção & controle , Feminino , Pesquisas sobre Atenção à Saúde , Troca de Informação em Saúde/normas , Humanos , Internato e Residência/métodos , Internato e Residência/normas , Masculino , Aplicativos Móveis/normas , Avaliação das Necessidades , Ortopedia/educação , Ortopedia/legislação & jurisprudência , Ortopedia/tendências , Encaminhamento e Consulta/ética , Encaminhamento e Consulta/normas , Smartphone , TurquiaAssuntos
Custos de Cuidados de Saúde/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Ortopedia/legislação & jurisprudência , Política , Seguro de Saúde Baseado em Valor , Aquisição Baseada em Valor/legislação & jurisprudência , Redução de Custos , Análise Custo-Benefício , Regulamentação Governamental , Política de Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/legislação & jurisprudência , Ortopedia/economia , Formulação de Políticas , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economiaRESUMO
Orthopedic surgeons frequently encounter medical malpractice claims. The purpose of this study was to assess trends and risk factors in lawsuits brought against orthopedic surgeons using a national legal database. A legal research service was used to search publicly available settlement and verdict reports between 1988 and 2013 by terms "orthopaedic or orthopedic" and "malpractice." Temporal trends were evaluated, and logistic regression was used to identify independent risk factors for case outcomes. A total of 1562 publicly reported malpractice cases brought against orthopedic surgeons, proceeding to trial during a 26-year period, were analyzed. The plaintiffs won 462 (30%) cases, with a mean award of $1.4 million. The frequency of litigation and pay-outs for plaintiffs increased 215% and 280%, respectively, between the first and last 5-year periods. The mean payout for plaintiff-favorable verdicts was highest in pediatrics ($2.6 million), followed by spine ($1.7 million) and oncology ($1.6 million). Fracture fixation (363 cases), arthroplasty (290 cases), and spine (231 cases) were the most commonly litigated procedures, while plaintiffs were most successful for fasciotomy (48%), infection-treating procedures (43%), and carpal tunnel release (37%). When analyzing data by state and region, adjusted for population, northeastern states had a higher frequency of lawsuits. Malpractice liability has increased during the past 3 decades while orthopedic surgeons continue to win most of the cases making it to court. As patients search for medical care via publicly available information, it is important for orthopedic surgeons to understand what aspects of their own practice carry different risks of litigation. [Orthopedics. 2019; 42(2):e260-e267.].
Assuntos
Imperícia/legislação & jurisprudência , Procedimentos Ortopédicos/legislação & jurisprudência , Artroplastia/legislação & jurisprudência , Artroplastia/tendências , Bases de Dados Factuais , Fasciotomia/legislação & jurisprudência , Fasciotomia/tendências , Feminino , Humanos , Modelos Logísticos , Masculino , Imperícia/tendências , Pessoa de Meia-Idade , Procedimentos Ortopédicos/tendências , Cirurgiões Ortopédicos/legislação & jurisprudência , Cirurgiões Ortopédicos/tendências , Ortopedia/legislação & jurisprudência , Ortopedia/tendências , Estudos Retrospectivos , Fatores de Risco , Estados UnidosRESUMO
BACKGROUND: The German health care system is well accepted, but efficiency, costs and patient satisfaction are sometimes criticised. Opinions and models prevail, and empirical data are rarely presented, although quantitative data are a precondition to assess the acceptance of the health care system. METHOD: To determine the appraisal of the patient-doctor relationship, economic situation and cooperation with clinical institutions, a 37 item was developed where participants indicated their agreement with a statement on a four point Likert scale. This questionnaire was answered by 525 German orthopaedic and/or traumatology surgeons, representing 7.7% of all German specialists working in outpatient care. RESULTS: 75% of all respondents felt challenged by demanding patients and a need for justification; what was less pronounced was the feeling of being exploited as physicians. Restrictions in medical treatment from budgeting expenses were seen by 74%. More than 90% considered that it was impossible to finance their medical practice expenses by conservative medical treatment only. The respondents felt similarly critical about the current cooperation with hospitals - only 19% were not interested in closer cooperation and 96% advocated higher fees for this cooperation. 74% confirmed that hospitals are taking over outpatient tasks, whereas only 35% agreed that more clinical patient care can be provided by outpatient providers, especially due to legal restrictions. DISCUSSION: Practitioning orthopaedic and traumatology surgeons feel exploited by uninformed patients, misallocation of reimbursement funds and legal restrictions, as well as unilateral substitution of outpatient care by hospitals. They do not consider that the current structures are sustainable for long term patient care.
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Assistência Ambulatorial/organização & administração , Atitude do Pessoal de Saúde , Ortopedia/organização & administração , Traumatologia/organização & administração , Assistência Ambulatorial/economia , Assistência Ambulatorial/legislação & jurisprudência , Assistência Ambulatorial/psicologia , Alemanha , Pesquisas sobre Atenção à Saúde , Humanos , Relações Interprofissionais , Estresse Ocupacional , Ortopedia/economia , Ortopedia/legislação & jurisprudência , Satisfação Pessoal , Relações Médico-Paciente , Cirurgiões/psicologia , Traumatologia/economia , Traumatologia/legislação & jurisprudênciaAssuntos
Ortopedia , Implantação de Prótese , Traumatologia , Atenção à Saúde/legislação & jurisprudência , Atenção à Saúde/normas , Alemanha , Humanos , Uso Excessivo dos Serviços de Saúde , Ortopedia/legislação & jurisprudência , Ortopedia/normas , Próteses e Implantes , Implantação de Prótese/legislação & jurisprudência , Implantação de Prótese/normas , Cirurgiões , Traumatologia/legislação & jurisprudência , Traumatologia/normasRESUMO
Health-care reform, market competition, cost containment, and pressure for productivity have dramatically impacted the practice of orthopaedic surgery and academic surgical training. Orthopaedic leaders and training programs are striving to identify and solve these contemporary challenges. Herein, we focus on 4 areas that currently pose important challenges to modern orthopaedic surgical departments and academic hospital systems, including the demanding and evolving skill sets that are required of physician leaders, the effects of the changing medical-legal environment on academic medicine, the impact of increased clinical productivity emphasis on surgical education, and departmental leadership transitions.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Docentes de Medicina/organização & administração , Liderança , Ortopedia/educação , Centros Médicos Acadêmicos/legislação & jurisprudência , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Eficiência , Reforma dos Serviços de Saúde , Humanos , Ortopedia/legislação & jurisprudência , Ortopedia/organização & administração , Sociedades Médicas , Estados UnidosRESUMO
BACKGROUND: Medical malpractice is an important topic worldwide, and orthopedics is a clinical branch that is considered to be at a high risk for claims. The analysis of a series of medmal insurance claims allows forensic pathologists, clinicians, and insurance companies to probe the risk of a specific clinical branch for medical malpractice claims and highlights areas where care may be improved. We investigated the main features of a major Italian insurance broker's archive in order to identify recurrent pitfalls in this field. MATERIALS AND METHODS: A retrospective study was carried out on orthopedics claims. The archive covered claims from 2002 to 2013 that targeted 1980 orthopedists. RESULTS: 635 claims were found and analyzed with a focus on the clinical activity invocked in the claim, the presence of alleged team malpractice, the clinical outcome of the case, and the final forensic decision regarding the claim. 299 orthopedists had at least one malpractice claim made against them during the available period; 146 orthopedists were subject to more than one malpractice claim. Most of the claims regarded perioperative and operative cases, usually originating from civil litigation. The anatomical sites most commonly involved were the hip or knees, and sciatic nerve lesions were the main contributor. CONCLUSIONS: Orthopedics is a medical specialty with a high risk for malpractice claims. In our study, medical malpractice was observed in nearly 50% of the cases-typically in surgery-linked cases resulting in permanent impairment of the patient. Death from orthopedics malpractice seemed to be rare. LEVEL OF EVIDENCE: IV.
Assuntos
Imperícia/estatística & dados numéricos , Procedimentos Ortopédicos/legislação & jurisprudência , Ortopedia/legislação & jurisprudência , Feminino , Humanos , Revisão da Utilização de Seguros , Itália , Masculino , Imperícia/legislação & jurisprudência , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: According to the American Academy of Orthopaedic Surgeons (AAOS) Standards of Professionalism, the responsible testimony of expert witnesses in orthopaedic surgery malpractice lawsuits is important to the public interest. However, these expert witnesses are recruited and compensated without established standards, and their testimony can potentially sway court opinion, with substantial consequences. The objective of this study was to characterize defense and plaintiff expert orthopaedic surgeon witnesses in orthopaedic surgery malpractice litigation. METHODS: Utilizing the WestlawNext legal database, defense and plaintiff expert witnesses involved in orthopaedic surgery malpractice lawsuits from 2013 to 2017 were identified. Each witness's subspecialty, mean years of experience, involvement in academic or private practice, fellowship training, and scholarly impact, as measured by the Hirsch index (h-index), were determined through a query of professional profiles, the Scopus database, and a PubMed search. Statistical comparisons were made for each parameter among defense and plaintiff expert witnesses. RESULTS: Between 2013 and 2017, 306 expert medical witnesses for orthopaedic cases were identified; 174 (56.9%) testified on behalf of the plaintiff, and 132 (43.1%) testified on behalf of the defense. Orthopaedic surgeons who identified themselves as general orthopaedists comprised the largest share of expert witnesses on both the plaintiff (n = 61) and defense (n = 25) sides. The plaintiff witnesses averaged 36 years of experience versus 31 years for the defense witnesses (p < 0.001); 26% of the plaintiff witnesses held an academic position versus 43% of the defense witnesses (p = 0.013). Defense witnesses exhibited a higher proportion of fellowship training in comparison to plaintiff expert witnesses (80.5% versus 64.5%, respectively, p = 0.003). The h-index for the plaintiff group was 6.6 versus 9.1 for the defense group (p = 0.04). Two witnesses testified for both the plaintiff and defense sides. CONCLUSIONS: Defense expert witnesses held higher rates of academic appointments and exhibited greater scholarly impact than their plaintiff counterparts, with both sides averaging >30 years of experience. These data collectively show that there are differences in characteristics between plaintiff and defense witnesses. Additional study is needed to illuminate the etiology of these differences.
Assuntos
Prova Pericial/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Cirurgiões Ortopédicos/legislação & jurisprudência , Ortopedia/legislação & jurisprudência , HumanosRESUMO
A recent study that evaluated the risk of facing a malpractice claim by physician specialty found that orthopedic surgeons were at a significantly greater risk of being sued than other medical specialists. To date, no studies have characterized trends in orthopedic surgery malpractice claims. The Westlaw legal database was used to locate state and federal jury verdicts and settlements related to medical malpractice and orthopedic surgery from 2010 to 2016. Eighty-one cases were analyzed. The mean age of the affected patients and/or plaintiffs was 53.4 years. Spine surgery (21 cases; 25.9%), knee surgery (17 cases; 21.0%), and hip surgery (11 cases; 13.6%) were litigated most often. Procedural error (71 cases; 87.7%) and negligence (58 cases; 71.6%) were the 2 most commonly cited reasons for litigation. The jury found in favor of the defendant in most (50 cases; 61.7%) of the cases. The mean plaintiff (17 cases; 21.0%) verdict payout was $3,015,872, and the mean settlement (13 cases; 16.0%) value was $1,570,833. Unnecessary surgery (odds ratio [OR], 12.29; 95% confidence interval [CI], 1.91-108.46; P=.040) and surgery resulting in death (OR, 26.26; 95% CI, 2.55-497.42; P=.040) were significant predictors of a verdict in favor of the plaintiff. Patient death (OR, 0.05; 95% CI, 0.01-0.38; P=.021) and male patient sex (OR, 0.26; 95% CI, 0.09-0.71; P=.033) were significant negative predictors of a verdict in favor of the defendant. The jury found in favor of the defendant orthopedic surgeon in most cases. Procedural error and/or negligence were cited most commonly by the plaintiffs as the bases for the claims. Verdicts in favor of the plaintiffs resulted in payouts nearly double those of settlements. [Orthopedics. 2018; 41(5):e615-e620.].
Assuntos
Imperícia , Ortopedia/legislação & jurisprudência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Bases de Dados Factuais , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Procedimentos Ortopédicos/legislação & jurisprudência , Cirurgiões Ortopédicos/legislação & jurisprudência , Estados Unidos , Procedimentos Desnecessários/estatística & dados numéricos , Adulto JovemAssuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Jurisprudência/história , Responsabilidade Legal/história , Cirurgiões Ortopédicos/legislação & jurisprudência , Ortopedia/legislação & jurisprudência , História do Século XXI , Humanos , Consentimento Livre e Esclarecido/história , Ortopedia/história , Pennsylvania , Relações Médico-PacienteRESUMO
BACKGROUND: The Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons. We also examined the relationship of the h-index to National Institutes of Health (NIH) funding. METHODS: The h-indices of faculty members at academic orthopaedic surgery residency programs were obtained using the Scopus database. The PPSA web site was used to abstract their 2014 industry payments. NIH funding data were obtained from the NIH web site. Mann-Whitney U testing and Spearman correlations were used to explore the relationships. RESULTS: Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments. CONCLUSIONS: There are large differences in industry payment size and distribution among academic surgeons. The small percentage of academic surgeons who receive industry research support or NIH funding tend to have higher h-indices. For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought.