Risk Management-Obstetrics and Gynecology Perspective.

The Obstetrics and Gynecology physician's likelihood to experience medical malpractice claims are higher than in other medical specialties. We will review the basic principles of health care risk management, the role of the risk manager, and the importance of health care risk management in risk mitigation for obstetrics and gynecology physicians. Attention is focused on medical record documentation, disclosure of adverse events, second victim programs, grievance management techniques, alternative dispute resolution concepts, regulatory inquiries including state licensure investigations, product failures, and electronic media strategies. Concluding, health care risk management may be used as a claim avoidance tool and provider protective vehicle for physicians.

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.

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.

Actions, behaviors, and characteristics of RNs involved in compensable injury.

Malpractice claims analysis offers valuable insight into nursing practice. A review of 16 malpractice claims involving 19 RNs identified their characteristics, actions, and behaviors that contributed to monetary compensation. Most events involved failure to perform a timely assessment and intervention. Relationships were found among nurses' characteristics and the severity of patient injury. Malpractice claims analysis affords nursing leaders the opportunity to involve RNs in correcting deficiencies that contribute to practice errors.