Compensated and non-compensated patient injury claims in internal carotid artery interventions in Finland, 2004-2017.

OBJECTIVES: Analysis of patient injuries offers possibilities for improving quality in patient care. The aim of this study was to identify errors and adverse events leading to patient injuries in the treatment of internal carotid artery stenosis (ICAS). METHODS: A retrospective analysis was performed on data from Finnish patient injury claims and patient insurance center decisions in the treatment of ICAS, 2004-2017. Contributing factors to injury were identified and evaluated. RESULTS: During the 14-year study period, 42 patient injury claims involving ICAS treatment were closed in Finland. One claim involved carotid artery stenting, and the other operations were carotid artery endarterectomies. Nine of the claims were compensated (seven for operations and two for evaluations). Fully trained vascular surgeons had carried out all the operations and evaluations. Stroke was the most common complaint in the claims (n = 12). Six of the compensated patients were symptomatic prior to the interventions. Injuries were related to errors in decision-making and patient selection in two cases. Four patients received compensation for nerve injury and three for stroke. No deaths were compensated as patient injuries. Most negative claim decisions were related to the injury having been unavoidable. CONCLUSION: Compensated patient injuries involving the treatment of ICAS are rare but often serious and mostly involve open surgery. Patient injury claims provide a valuable source of information for recognizing errors in care and offer possibilities to improve patient safety.

Compensated Patient Injuries in the Treatment of Abdominal Aortic and Iliac Artery Aneurysms in Finland: A Nationwide Patient Insurance Registry Study.

OBJECTIVES: Patient injury claims data and insurance records provide detailed information on patient injuries. This study aimed to identify the errors and adverse events that led to patient injuries in vascular surgery for the treatments of abdominal aortic aneurysms (AAA) and iliac artery aneurysms (IAA) in Finland. The study also assessed the severity and preventability of the injuries. MATERIALS AND METHODS: A retrospective analysis of Finnish Patient Insurance Centre's insurance charts of compensated patient injuries in the treatment of AAA and IAA. Records of all compensated patient injury claims involving AAA and IAA between 2004 and 2017 inclusive were reviewed. Contributing factors to injury were identified and classified. The injuries were assessed for their preventability by using the WHO Surgical Safety Checklist correctly. The degree of harm was graded by Clavien-Dindo classification. RESULTS: Twenty-six patient injury incidents were identified in the treatment of 23 patients. Typical injuries involved delays in diagnosis or treatment, errors in surgical technique or injuries to adjacent anatomic organs. Three (13.0%) patients died due to patient injury. Two deaths were caused by delays in diagnosis of ruptured abdominal aortic aneurysm (RAAA) and the third death was due to missed diagnosis of post-operative myocardial infarction. Retained foreign material caused injuries to two (8.7%) patients. One (4.3%) patient had a severe postoperative infection. Three (13.0%) patients experienced an injury to an adjacent organ. One patient had a bilateral and another a unilateral above-the-knee amputation due to patient injury. Three injuries were considered preventable. Most harms were grade IIIb Clavien-Dindo classification in which injured patients required a surgical intervention under general anesthesia. CONCLUSIONS: Compensated patient injuries involving the treatment of AAA and IAA are rare, but are often serious. Injuries were identified during all stages of care. Most injuries involved open surgical procedures.

Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017.

OBJECTIVES: This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI). METHODS: PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified. RESULTS: Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal. CONCLUSIONS: PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common.

Patient Injuries in Treatment of Peripheral Arterial Disease in Finland: Review of National Patient Insurance Charts.

BACKGROUND: Patient injury claim data and insurance records constitute detailed sources of information on patient injuries and their contributing or causal factors. This study aimed to identify the unintended incidents that lead to patient injuries in vascular surgery in the treatment of peripheral arterial disease (PAD) in Finland. METHODS: The records of all accepted patient injury claims involving PAD between 2004 and 2017 inclusive were obtained from the nationwide Finnish Patient Insurance Centre registry and were reviewed. Factors contributing to injury were classified by patient careflow. RESULTS: Sixty-nine patient injury incidents were identified in 60 treated patients with PAD. Sixteen injuries (23.2%) were related to outpatient or preoperative care. Twenty-seven injuries (39.1%) were caused by incidents in performing open or endovascular procedures, and 26 injuries (37.7%) were related to postoperative care. Delay in treatment affected 11 (18.3%) patients. Incidents involving surgical technique were identified in the treatment of 13 (21.7%) patients. Retained foreign material caused injuries to four (6.7%) patients. Five (8.3%) patients suffered from postoperative hemorrhage and eleven (18.3%) from infection damage. Delay in treatment resulted in two major amputations. Technical problems in bypass operations led to the loss of the bypass graft and to reoperation. Three nerve injuries led to permanent disability. One (1.7%) patient died because of fatal postoperative bleeding after being discharged from the hospital. CONCLUSIONS: Compensated patient injuries in the treatment of PAD are rare. Injuries occur during all stages of care and are caused by both surgical system procedural failures and common complications.