Management of testicular torsion in the ER: lessons learned from medical professional liability claims.

OBJECTIVE: To evaluate emergency care for testicular torsion (TT) in medical professional liability (MPL) claims. METHODS: Claims related to TT from 2000 to 2018 were located. The assistance provided and the association with MPL were analyzed. RESULTS: Eighty complaints were identified, testicular pain was reported in 83.75% of first consultations, with a mean evolution time of 15.5 h. The mean time to diagnosis was 7.98 days. The first consultation was at the hospital in 75.1% of cases, but an ultrasound was performed only in 7.5%. When TT diagnosis was performed, 97.3% had undergone ancillary tests. The MPL was significantly associated with non-criminal proceedings and with less than 6 h of symptoms' evolution, and, within this subgroup, without undergoing an ultrasound scan. CONCLUSIONS: Late consultations, wrong diagnosis and late diagnosis are claimed. When MPL are claimed by means of non-criminal law, the existence of responsibility is frequently considered, even more in those cases when the consultation took place before 6 h of evolution with no ancillary tests having been performed.

El manejo de la torsión testicular en Urgencias: lecciones aprendidas de las reclamaciones por responsabilidad profesional médica / Management of testicular torsion in the ER: Lessons learned from medical professional liability claims

Objetivo: Evaluar la atención en Urgencias por torsión testicular en reclamaciones por responsabilidad profesional médica.MétodoSe extrajeron las reclamaciones relacionadas con torsión testicular del 2000 al 2018, analizando la asistencia dispensada y la asociación con responsabilidad profesional médica.ResultadosSe identificaron 80 reclamaciones, registrándose como síntoma principal el dolor testicular en el 83,75% de las primeras asistencias, con 15,5h de evolución media. El tiempo hasta el diagnóstico fue de 7,98 días de media. La primera consulta fue hospitalaria en el 75,1% de los casos, pero solo en el 7,5% se realizó ecografía. Cuando se diagnosticó la torsión testicular, se hizo uso de pruebas complementarias en el 97,3% de los casos. La responsabilidad profesional médica se asoció significativamente con la vía de reclamación no penal y con cuadros de menos de 6h de evolución, y dentro de este subgrupo, con la no realización de ecografía.ConclusionesSe reclaman consultas tardías, el error y el retraso en el diagnóstico. Cuando la reclamación es por vía no penal, es frecuente que se considere la existencia de responsabilidad, y más en los casos en que la consulta fue antes de las 6h y sin haber realizado prueba complementaria alguna. (AU)

Objective: To evaluate emergency care for testicular torsion in medical professional liability claims.MethodClaims related to testicular torsion from 2000 to 2018 were located. The assistance provided and the association with medical professional liability were analyzed.ResultsEighty complaints were identified, testicular pain was reported in 83.75% of first consultations, with a mean evolution time of 15.5h. The mean time to diagnosis was 7.98 days. The first consultation was at the hospital in 75.1% of cases, but an ultrasound was performed only in 7.5%. When testicular torsion diagnosis was performed, 97.3% had undergone ancillary tests. The medical professional liability was significantly associated with non-criminal proceedings and with less than 6h of symptoms’ evolution, and, within this subgroup, without undergoing an ultrasound scan.ConclusionsLate consultations, wrong diagnosis and late diagnosis are claimed. When medical professional liability are claimed by means of non-criminal law, the existence of responsibility is frequently considered, even more in those cases when the consultation took place before 6h of evolution with no ancillary tests having been performed. (AU)

[Analysis of claims for wrong-site surgery (1986-2017)]. / Reclamaciones por cirugía en sitio erróneo (1986- 2017).

BACKGROUND: Wrong site surgery (WSS) is a potentially preventable adverse event in healthcare. METHODS: We performed a retrospective analysis of the 9,129 claims managed by the Professional Liability Service of the Catalonian's Colleges of Physicians from 1986 to 2017. RESULTS: We identified 57 claims for WSS (1.78 per year), with an increase in the final ten years (0.92 to 3.83). One patient identification error corresponded to the anesthetic procedure; surgery involving fingers (17.5%), backbone (15.8%), knee (12.3%) and teeth (12.3%) was predominant. Orthopedic Surgery and Traumatology was the specialty most involved (54.4%), being tooth extraction, vertebral disc prolapsed surgery and finger bone resection the most frequent procedures with seven cases each (12.3%). Claims followed criminal (16 cases, 28.1%) or civil proceedings (9 cases, 15.8%), with two guilty verdicts on a civil basis. The frequency of claims leading to compensation was 59.6%, averaged 9,210.23 euros per claim, resolved through extrajudicial (65.6%) or judicial channels (50.0%). CONCLUSION: WSS events cannot be overlooked and shows high incidence of claims liability rates, which highlights the need to increase efforts to ensure patient safety in this area.

Reclamaciones por cirugía en sitio erróneo (1986-2017) / Analysis of claims for wrong-site surgery (1986-2017)

Fundamento: La cirugía en sitio erróneo (CSE) es un evento adverso de la asistencia sanitaria potencialmente prevenible. Material y método: Análisis retrospectivo de las 9.129 reclamaciones registradas entre 1986 y 2017 en el Servicio de Responsabilidad Profesional Médica del Consejo de Colegios de Médicos de Cataluña. Resultados: Se localizaron 57 reclamaciones sobre CSE (1,78 reclamaciones/año) con incremento en los últimos diez años (0,92 a 3,83). Hubo un error de paciente correspondiente al procedimiento anestésico; las zonas anatómicas más implicadas fueron los dedos (17,5%) y la columna (15,8%), seguidos de la rodilla y los dientes (12,3% cada uno). Cirugía Ortopédica y Traumatología fue la especialidad más implicada (54,4%). Los procedimientos más frecuentemente implicados en la CSE fueron extracción dental, cirugía de hernia discal y resección ósea en dedo (7 casos cada uno, 12,3%). La vía de reclamación fue penal en 16 casos (28,1%) y civil en 9 (15,8%), con dos sentencias condenatorias por vía civil. El 59,6% de los expedientes conllevaron indemnización, con una cuantía media de 9.210,23 euros por caso, un 65,6% en vía extrajudicial y un 50% en vía judicial. Conclusiones: La CSE presenta una incidencia no desdeñable de reclamación y elevadas tasas de responsabilidad profesional médica, reforzando la necesidad de incrementar los esfuerzos en materia de seguridad del paciente en esta área

Background: Wrong site surgery (WSS) is a potentially preventable adverse event in healthcare. Methods: We performed a retrospective analysis of the 9,129 claims managed by the Professional Liability Service of the Catalonian’s Colleges of Physicians from 1986 to 2017. Results: We identified 57 claims for WSS (1.78 per year), with an increase in the final ten years (0.92 to 3.83). One patient identification error corresponded to the anesthetic procedure; surgery involving fingers (17.5%), backbone (15.8%), knee (12.3%) and teeth (12.3%) was predominant. Orthopedic Surgery and Traumatology was the specialty most involved (54.4%), being tooth extraction, vertebral disc prolapsed surgery and finger bone resection the most frequent procedures with seven cases each (12.3%). Claims followed criminal (16 cases, 28.1%) or civil proceedings (9 cases, 15.8%), with two guilty verdicts on a civil basis. The frequency of claims leading to compensation was 59.6%, averaged 9,210.23 euros per claim, resolved through extrajudicial (65.6%) or judicial channels (50.0%). Conclusion: WSS events cannot be overlooked and shows high incidence of claims liability rates, which highlights the need to increase efforts to ensure patient safety in this area

Malpractice risk at the physician level: Claim-prone physicians.

Professional liability and patient safety are worldwide concerns and efforts to identify claimed physicians' characteristics cross borders. Interventions with "at risk populations" would help to better address the underlying problems that lead to many claims. We analyzed physicians' characteristics of every paid claim between 2005 and 2014 in Catalonia region (Spain). We identified 808 physicians involved in 725 paid claims. A total of 12.38% physicians had at least two paid claims over the study period. Physicians' risk of future paid claims was increased if they had more than one previous paid claim (hazard ratio, 1.87; 95% confidence interval [CI], 1.67-2,1). More than half the claims were accounted for by physicians in four specialty groups: obstetrics and gynecology (20.4%), traumatology and orthopedic Surgery (17.5%), plastic surgery (10%) and general surgery (9.7%). The risk of recurrence was higher among surgery-related specialties than among non-surgery-related specialties. Specialty is a particularly strong determinant of claim incidence, so the risk issue may not be so individually determined, but conditioned by the kind of medicine or procedures we practice. Nevertheless, physicians' risk of future paid-claims increases after the second claim. Management systems should take advantage of this information, in order to prevent patient safety events and malpractice claims. Our results support both specialty-based interventions in high-risk specialties, such us Plastic Surgery, as well as interventions at a physician level in those physicians with more than one paid claim.

Meningitis y responsabilidad profesional médica en pediatría: ¿en qué podemos mejorar? / Meningitis and professional medical liability in pediatrics: How can we improve?

Introducción: La meningitis es un problema de salud pública con repercusiones en materia de responsabilidad profesional médica (RPM), de especial interés en pediatría. El estudio de las reclamaciones permite guiar las posibles mejoras en seguridad clínica. Metodología: Se analizaron las características clínicas, microbiológicas y jurídicas de las reclamaciones relacionadas con la meningitis, interpuestas ante el Consejo de Colegios de Médicos de Cataluña entre 1988 y 2014, junto con el estudio descriptivo y analítico de los casos. Resultados: Se analizaron 53 casos (1,96 casos/año) con una tasa de RPM del 24,53%. Los casos implicaron con frecuencia a menores (54,7%), con un diagnóstico inicial de síndrome febril inespecífico (45,5%). La tasa de RPM fue significativamente mayor en los casos relacionados con la cirugía, si no se producía el fallecimiento del paciente y si existía defecto de asepsia. Los microorganismos más comunes fueron Neisseria meningitidis y Streptococcus pneumoniae. Conclusiones: La asistencia a la meningitis es un campo que requiere mejoras en seguridad clínica en pediatría, si bien resulta especialmente evidente la necesidad de revisar ciertos aspectos, como la asepsia en la anestesia y la cirugía

Introduction: Meningitis is a public health problem with implications for medical professional liability (MPL) of special interest for pediatricians. The study of claims potentially guides improvements in clinical safety. Methods: We analyzed the clinical, microbiological and legal characteristics of the complaints related to meningitis filed against the Council of Physicians' Colleges of Catalonia between 1988 and 2014, with a descriptive and analytical study of the cases.Results: We analyzed 53 cases (1.96 cases per year) with a MPL rate of 24.53%. The cases frequently involved minors (54.7%), with an initial diagnosis of non-specific febrile syndrome (45.5%). The MPL rate was significantly higher in cases related to surgery, when death did not occur and when asepsis defect existed. The most common microorganisms were Neisseria meningitidis and Streptococcus pneumoniae. Conclusions: Pediatric care of meningitis needs improvements in clinical safety, but results highlight the risk of other areas such as those related to asepsis in anesthesia and surgery

Catastrophic Medical Malpractice Payouts in Spain.

Patient safety and professional liability are major concerns worldwide. Despite the pervasive influence of catastrophic malpractice payouts, little is known about the specific characteristics and the overall relevance and characteristics of these payouts, especially outside U.S. borders. Five hundred fifty claims led to a payout among 2,236 claims from January 1, 2004 to December 31, 2010, in Catalonia (Spain). We analyzed data on patient, provider, and claim characteristics. Accordingly to our sample, Spanish catastrophic payouts (SCP) were defined as payouts over &OV0556;200,000, which was found in 32 cases (5.8%). Diagnostic errors and patient death were not as relevant as previously reported. However, it is remarkable that the literature emanating from different countries shows similar trends besides contextual differences: patients suffering minor injuries are not likely to receive a catastrophic payout, catastrophic payouts are associated with patient age less than one; SCP are most associated with anesthesiology and resuscitation, general surgery, and obstetrics and gynecology; and SCP were more likely to occur when a case went to trial compared to when a case was settled out of court. Studies, such as this, provide a wider picture of the medical liability worldwide reality and helps avoiding isolated discourses.

[Surgical procedures involved in claims for alleged defects in praxis]. / Procedimientos quirúrgicos objeto de reclamación por presunto defecto de praxis.

Medical professional liability and adverse events in health care are major concerns worldwide and the analysis of claims for alleged defects in praxis is a potential source of knowledge. High rates of adverse events and complaints have been reported in surgical procedures. This article analyzes the claims registered by the Council of Medical Colleges in Catalonia between 1986 and 2012, and explores surgical procedures claimed (ICD- 9-CM coding), as well as the final outcome of the claim. Among the 5,419 records identified on surgical procedures, the interventions of the musculoskeletal system and skin and integument showed the highest frequencies. Interventions related to "non-curative" medicine should be emphasized because of their higher rates of economical agreement or condemnation outcomes, which were significantly higher for mastopexia. The results underscore the importance of the surgical area in medical professional liability and the high risk of payouts among those procedures belonging to the so-called "non-curative" medicine.

Procedimientos quirúrgicos objeto de reclamación por presunto defecto de praxis / Surgical procedures involved in claims for alleged defects in praxis

La responsabilidad profesional médica y los episodios adversos en la asistencia sanitaria son preocupaciones de primer orden en el ámbito internacional y el análisis de las reclamaciones por presunto defecto de praxis supone una potencial fuente de conocimiento. Se han descrito tasas específicamente elevadas de episodios adversos y reclamaciones en los procedimientos quirúrgicos. El presente artículo analiza las reclamaciones interpuestas ante el Consejo de Colegios de Médicos de Cataluña entre los años 1986 y 2012, mediante la exploración de los procedimientos quirúrgicos reclamados mediante codificación CIE-9-MC, así como el resultado final de la reclamación. Entre los 5.419 expedientes identificados sobre procedimientos quirúrgicos destacaron, por su elevada frecuencia, las intervenciones del sistema musculoesquelético y de piel y tegumentos. Las intervenciones correspondientes a la medicina «no curativa» destacaron por sus elevadas tasas de procedimientos que finalizaron mediante acuerdo transaccional o condena, que resultó significativamente mayor para las mastopexias. Los resultados obtenidos subrayan la importancia del área quirúrgica en responsabilidad profesional médica y el riesgo elevado de condena de los procedimientos pertenecientes a la denominada «medicina satisfactiva o no curativa» (AU)

Medical professional liability and adverse events in health care are major concerns worldwide and the analysis of claims for alleged defects in praxis is a potential source of knowledge. High rates of adverse events and complaints have been reported in surgical procedures. This article analyzes the claims registered by the Council of Medical Colleges in Catalonia between 1986 and 2012, and explores surgical procedures claimed (ICD- 9-CM coding), as well as the final outcome of the claim. Among the 5,419 records identified on surgical procedures, the interventions of the musculoskeletal system and skin and integument showed the highest frequencies. Interventions related to «non-curative» medicine should be emphasized because of their higher rates of economical agreement or condemnation outcomes, which were significantly higher for mastopexia. The results underscore the importance of the surgical area in medical professional liability and the high risk of payouts among those procedures belonging to the so-called «non-curative» medicine (AU)

[Evaluation of the Glucocard Memory 2 analyzer for measuring glucose concentration in capillary blood]. / Evaluación del analizador Glucocard Memory 2 para medir la concentración de glucosa en sangre capilar.

OBJECTIVE: To evaluate the analytical reliability and accuracy as well as the practicability of the Glucocard Memory 2 glucose meter, intended to the control of the diabetic patient. DESIGN: Descriptive, crossover study. To validate an analytical instrument according to guidelines of the Spanish Society of Clinical Biochemistry and Molecular Pathology. SETTING: Primary health care, urban setting. PARTICIPANTS: Ninety-three blood samples from diabetic patients were used. These samples were selected by a consecutive sampling of the tubes received in the laboratory for the diabetes follow-up protocol. MEASUREMENTS AND MAIN RESULTS: Repeatability of the system was studied analysing the within-run precision at four concentrations of glucose. We obtained coefficients of variation between 2.12% (at 410 mg/dl of glucose) and 4.17% (at 37.2 mg/dl). The linearity study allowed to check experimentally the linear response of the instrument between 27 and 485 mg/dl. The accuracy was evaluated comparing the Glucocard results with the routine procedure of our laboratory (Hitachi 747, GOD-PAP) and calculating the regression parameters with the Passing and Bablok method (y = 1.01 x -2.34) and the intraclass correlation (99%). To evaluate the clinical significance of possible deviations related with the reference laboratory method the "error Grid" analysis was used. This analysis showed that 100% of Glucocard Memory 2 results fell into the clinical accuracy zone. Practicability study showed that the instrument is very simple to use. CONCLUSIONS: Glucocard Memory 2 is a glucose meter intended to the measurement of glucose both on capillary and venous blood that, besides its extreme simplicity of use, shows very good analytical features.

Evaluación del analizador glucocard memory 2 para medir la concentración de glucosa en sangre capilar / Evaluation of the glucocard memory 2 analyser for measuring glucose concentration in capillary blood

Objetivo. Evaluar la validez y precisión analítica y la practicabilidad del sistema medidor de la concentración de glucosa Glucocard Memory 2 diseñado para el autocontrol del paciente diabético. Diseño. Descriptivo, transversal. Validación de un instrumento de medida siguiendo las recomendaciones de la Sociedad Española de Bioquímica Clínica y Patología Molecular. Emplazamiento. Estudio realizado en un laboratorio de atención primaria. Muestra. Noventa y tres muestras de sangre de pacientes diabéticos seleccionadas mediante muestreo consecutivo de los tubos recibidos en el laboratorio para realizar el protocolo analítico de seguimiento de diabetes. Mediciones y resultados principales. La repetibilidad del sistema se estudió analizando la precisión intradía a 4 concentraciones distintas de glucosa, obteniéndose coeficientes de variación entre el 2,12 por ciento (a 410 mg/dl de glucosa) y un 4,17 por ciento (a 37,2 mg/dl). La linealidad del analizador se demostró experimentalmente entre 27 y 485 mg/dl. La exactitud se evaluó por comparación con el procedimiento habitual del laboratorio (Hitachi 747, GOD-PAP), calculando la recta de regresión mediante el método de Passing-Bablok (y = 1,01, * -2,34) y mediante la obtención del coeficiente de correlación intraclase, cuyo resultado fue del 99 por ciento. La técnica de análisis de 'error Grid' para investigar la significación clínica de las posibles desviaciones respecto al método de referencia dio un 100 por ciento de resultados dentro de la zona de exactitud clínica. El estudio de la practicabilidad mostró una gran simplicidad de manejo. Conclusiones. El Glucocard Memory 2 es un analizador para la medición de la glucemia capilar y venosa con una extrema simplicidad de manejo y unas excelentes características analíticas (AU)

In-hospital case-fatality of aged patients with hip fracture in Catalonia, Spain.

Hip fracture case-fatality in patients aged 65 years or older was studied in patients admitted to acute care hospitals in Catalonia over a 1-year period. 1222 femoral neck fractures and 1648 pertrochanteric fractures were identified. Women (76.9%) were most frequently and significantly older than men. Average age in pertrochanteric fracture was significantly higher than cervical fracture. The overall in-hospital case-fatality rate was 6.8%. Male gender, advanced age, pertrochanteric fracture and conservative management were associated with a significantly higher case-fatality rate. Multivariate logistic regression analyses demonstrated that previously seen associations showed univariate analysis. However, because interaction was observed, association within fracture and case-fatality was studied separately by gender. Men with pertrochanteric fracture showed the greatest association for in-hospital case-fatality (OR: 3.3; 95% CI: 2-5.5) compared with women with femoral neck fractures. In models with in-hospital case-fatality or no autonomy at discharge or in-hospital case-fatality or no autonomy at discharge or readmission as dependent variables, the odds ratio of death for conservative management of hip fracture were 3.7 (95% CI: 2.3-6) and 3.1 (95% CI: 1.9-4.9), respectively. This information should be taken into consideration for further analyses for long-term outcome and resource consumption by patients with hip fracture.