Hidden Otolaryngology Malpractice Claims: An Internal Review From 2000 to 2020.

OBJECTIVE: To report key characteristics and patterns of captive insurance claims not publicly reported in otolaryngology across a large tertiary-level academic health system over the previous 2 decades. STUDY DESIGN: Case series. SETTING: The tertiary care health system. METHODS: The internal captive insurance database at a tertiary level healthcare system was queried to identify otolaryngology-related malpractice claims regardless of final disposition (settled or dismissed) filed from 2000 to 2020. The date of the incident, date of claim, error type, patient outcome, provider subspecialty, total expenses, disposition, and final reward amount were recorded. RESULTS: Twenty-eight claims were identified. There were 11 (39.3%) claims from 2000 to 2010 and 17 (60.7%) claims from 2011 to 2020. Head and neck surgery was the most frequently implicated subspecialty (n = 9, 32.1% of all cases), followed by general otolaryngology (n = 7, 25.0%), pediatrics (n = 5, 17.9%), skull base/rhinology (n = 4, 14.3%), and laryngology (n = 1, 3.6%). Improper surgical performance was cited in 35.7% of cases (n = 10), followed by failure to diagnose (n = 8, 28.6%), to treat (n = 4, 14.3%), and to obtain informed consent (n = 3, 10.7%). While 2 cases are ongoing, a total of 17/26 (65.4%) cases were settled and 20/26 (76.9%) dismissed some or all parties. Dismissed claims had significantly higher expenses (p = .022) and duration from incident to disposition (p = .013) compared to settled claims. CONCLUSION: This study expands the malpractice landscape in otolaryngology by including data not readily available through public sources and compares it to national trends. These findings encourage otolaryngologists to better gauge current quality and safety measures that best protect patients from harm.

Do Written Disclosures of Serious Events Increase Risk of Malpractice Claims? One Health Care System's Experience.

OBJECTIVE: This study aimed to determine whether Pennsylvania ACT 13 of 2002 (Mcare) requiring the written and verbal disclosure of "serious events" was accompanied by increased malpractice claims or compensation costs in a large U.S. health system. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of malpractice claims. The secondary outcome was the amount paid for compensation of malpractice claims. The analyses tested the relationship between the rate of serious event disclosures and the outcome variables, adjusted for the year of the event, category of claim, and the degree of "harm" related to the event. RESULTS: There were 15,028 serious event disclosures and 1302 total malpractice claims among 1,587,842 patients admitted to UPMC hospitals from May 17, 2002, to June 30, 2011. As the number of serious event disclosures increased, the number of malpractice claims per 1000 admissions remained between 0.62 and 1.03. Based on a matched analysis of claims that were disclosed and those that were not (195 pairs), disclosure status was significantly associated with increased claim payout (disclosures had 2.71 times the payout; 95% confidence interval, 1.56-4.72). Claims with higher harm levels H and I were independently associated with higher payouts than claims with lower harm levels A to D (11.15 times the payout; 95% confidence interval, 2.30-54.07). CONCLUSIONS AND RELEVANCE: Implementation of a mandated serious event disclosure law in Pennsylvania was not associated with an overall increase in malpractice claims filed. Among events of similar degree of harm, disclosed events had higher compensation paid compared with those that had not been disclosed.

Perioperative dental injury at a tertiary care health system: An eight-year audit of 816,690 anesthetics.

Among all complications of airway management, dental injury is the most common cause of patient complaints with medicolegal consequences. Over an 8-year period, data on dental injury were collected within a large university hospital system that included community, tertiary, and quaternary care centers. Patient characteristics were compared among all patients receiving anesthesia care using billing data collected from the same period. Of the 816,690 patients who received anesthesia care, there were 360 dental injuries, giving an overall incidence of 1:2,269 (0.044%). Patients receiving general anesthesia were at an increased risk for dental injuries, with an incidence of 1:1,754 (0.057%) compared with patients receiving monitored anesthesia care in whom the incidence was 1:12,500 (0.008%). Patients in the age group 18 to 65 years had a higher incidence of dental injuries of 1:1,818 (0.055%) compared with pediatric patients, who had an incidence of 1:7,692 (0.013%). Emergency procedures were not associated with an increased risk of dental injury in the 816,690 cases. However, of the 360 patients who sustained a dental injury, emergency procedures were associated with a higher incidence of injuring multiple teeth.

The nurse's role in the causation of compensable injury.

Mistakes can be life-threatening and result in malpractice claims. There are few studies that discuss malpractice claims and nursing. The purpose was to identify possible relationships between the actions, behaviors, or characteristics of RNs and the injury suffered by a patient involved in a compensable event. Claims were analyzed retrospectively. Using the Fischer exact test, nurse inaction yielded a higher patient outcome severity score. No single nurse behavior or characteristic was significantly related to the patient outcome severity score. Findings support the belief that system problems may be a contributing factor.

Senior executive adopt-a-work unit: a model for safety improvement.

BACKGROUND: At The Johns Hopkins Hospital (JHH), the patient safety committee created a safety program that focused on encouraging staff in selected units to identify and eliminate potential errors in the patient care environment. As part of this program, senior hospital executives each adopted an intensive care unit and worked with the unit staff to identify issues and to empower staff to address safety issues. JHH PATIENT SAFETY PROGRAM: The program consisted of eight steps, which together require six months for implementation: (1) conduct a culture survey; (2) educate staff on the science of safety; (3) identify staff safety concerns through a staff safety survey; (4) implement the senior executive adopt-a-work unit program; (5) implement improvements; (6-7) document results, share stories, and disseminate results; and (8) resurvey staff. RESULTS: The senior executive adopt-a-work unit program was successful in identifying and eliminating hazards to patient safety and in creating a culture of safety. DISCUSSION: The program can be broadly implemented. The keys to program success are the active role of an executive advocate and staff's willingness to openly discuss safety issues on the units. Regular meetings between the advocates and the units have provided a forum for enhancing executive awareness, increasing staff confidence and trust in executive involvement, and swiftly and effectively addressing areas of potential patient harm.