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2.
JAMA ; 323(4): 352-366, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990319

RESUMO

Importance: The tort liability system is intended to serve 3 functions: compensate patients who sustain injury from negligence, provide corrective justice, and deter negligence. Deterrence, in theory, occurs because clinicians know that they may experience adverse consequences if they negligently injure patients. Objective: To review empirical findings regarding the association between malpractice liability risk (ie, the extent to which clinicians face the threat of being sued and having to pay damages) and health care quality and safety. Data Sources and Study Selection: Systematic search of multiple databases for studies published between January 1, 1990, and November 25, 2019, examining the relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality. Data Extraction and Synthesis: Information on the exposure and outcome measures, results, and acknowledged limitations was extracted by 2 reviewers. Meta-analytic pooling was not possible due to variations in study designs; therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures: Associations between malpractice risk measures and health care quality and safety outcomes. Exposure measures included physicians' malpractice insurance premiums, state tort reforms, frequency of paid claims, average claim payment, physicians' claims history, total malpractice payments, jury awards, the presence of an immunity from malpractice liability, the Centers for Medicare & Medicaid Services' Medicare malpractice geographic practice cost index, and composite measures combining these measures. Outcome measures included patient mortality; hospital readmissions, avoidable admissions, and prolonged length of stay; receipt of cancer screening; Agency for Healthcare Research and Quality patient safety indicators and other measures of adverse events; measures of hospital and nursing home quality; and patient satisfaction. Results: Thirty-seven studies were included; 28 examined hospital care only and 16 focused on obstetrical care. Among obstetrical care studies, 9 found no significant association between liability risk and outcomes (such as Apgar score and birth injuries) and 7 found limited evidence for an association. Among 20 studies of patient mortality in nonobstetrical care settings, 15 found no evidence of an association with liability risk and 5 found limited evidence. Among 7 studies that examined hospital readmissions and avoidable initial hospitalizations, none found evidence of an association between liability risk and outcomes. Among 12 studies of other measures (eg, patient safety indicators, process-of-care quality measures, patient satisfaction), 7 found no association between liability risk and these outcomes and 5 identified significant associations in some analyses. Conclusions and Relevance: In this systematic review, most studies found no association between measures of malpractice liability risk and health care quality and outcomes. Although gaps in the evidence remain, the available findings suggested that greater tort liability, at least in its current form, was not associated with improved quality of care.


Assuntos
Responsabilidade Legal , Imperícia/legislação & jurisprudência , Qualidade da Assistência à Saúde , Humanos , Seguro de Responsabilidade Civil/economia , Imperícia/economia , Imperícia/estatística & dados numéricos , Obstetrícia/normas , Complicações Pós-Operatórias
3.
Urologe A ; 59(1): 87-98, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31728563

RESUMO

The juridification of medicine affects all disciplines, including urology. Therefore, in this discipline it can well happen that patients not only feel wrongly treated or complain that a treatment was not performed lege artis but also demand compensation or even bring criminal charges. From the patient point of view, the doctor is often more likely to blame for a complication that has arisen or for a hoped for but failed treatment success, than that it is accepted that a complication is typical for the intervention, which, despite the greatest medical care, unfortunately can become reality and is a fateful course. Insurance against claims for damages can be taken out. Not to be underestimated, however, is the personal burden of the accusations with which doctors are confronted by patients, relatives, expert witnesses and courts and against which one must defend oneself. This can mean additional work in addition to the normal medical workload. Therefore, the legal pitfalls in urology should be known.


Assuntos
Imperícia/legislação & jurisprudência , Urologia/legislação & jurisprudência , Compensação e Reparação/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Humanos , Seguro de Responsabilidade Civil/economia , Seguro de Responsabilidade Civil/legislação & jurisprudência , Responsabilidade Legal/economia , Imperícia/economia , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Relações Profissional-Família , Urologia/economia
4.
J Surg Res ; 245: 212-216, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421365

RESUMO

BACKGROUND: Pulmonary embolism and deep vein thrombosis are common clinical entities, and the related malpractice suits affect all medical subspecialties. Claims from malpractice litigation were analyzed to understand the demographics of these lawsuits and the common reasons for pursuing litigation. METHODS: Cases entered into the Westlaw database from March 5, 1987, to May 31, 2018, were reviewed. Search terms included "pulmonary embolism" and "deep vein thrombosis." RESULTS: A total of 277 cases were identified. The most frequently identified defendant was an internist (including family practitioner; 33%), followed by an emergency physician (18%), an orthopedic surgeon (16%), and an obstetrician/gynecologist (9%). The most common etiology for pulmonary embolism was prior surgery (41%). The most common allegation was "failure to diagnose and treat" in 62%. Other negligence included the failure to administer prophylactic anticoagulation while in the hospital (18%), failure to prescribe anticoagulation on discharge (8%), failure to administer anticoagulation after diagnosis (8%), and premature discontinuation of anticoagulation (2%). The most frequently claimed injury was death in 222 cases (80%). Verdicts were found for the defendant in 57% of cases and for the plaintiff in 27% and settled in 16%. CONCLUSIONS: The most frequently cited negligent act was the failure to give prophylactic anticoagulation, even after discharge. The trends noted in this study may potentially be addressed and therefore prevented by systems-based practice changes. The most common allegation, "failure to diagnose and treat," suggests that first-contact doctors such as emergency physicians and primary care practitioners must maintain a high index of suspicion for deep vein thrombosis/pulmonary embolism.


Assuntos
Falha da Terapia de Resgate/estatística & dados numéricos , Imperícia/estatística & dados numéricos , Médicos/estatística & dados numéricos , Embolia Pulmonar/terapia , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Bases de Dados Factuais/estatística & dados numéricos , Diagnóstico Tardio/economia , Diagnóstico Tardio/legislação & jurisprudência , Diagnóstico Tardio/estatística & dados numéricos , Falha da Terapia de Resgate/economia , Falha da Terapia de Resgate/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/estatística & dados numéricos , Imperícia/economia , Médicos/economia , Médicos/legislação & jurisprudência , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estados Unidos/epidemiologia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Trombose Venosa/mortalidade
5.
Postgrad Med ; 131(8): 607-611, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31452426

RESUMO

Objectives: Thyroid disease is managed by primary and a range of secondary care specialties. Interventions for common thyroid conditions are effective, but delays in diagnosis, ineffective or inappropriate treatment may affect outcomes and be subject to litigation. This study aimed to analyze trends in thyroid malpractice litigation in the UK over a 14-year period.Methods: This retrospective cohort study analyzed negligence claims recorded by the NHS Litigation Authority from 2002 to 2016. Data on incident details, outcomes, time to settlement, costs, and specialties involved were collected and analyzed.Results: Out of 189 cases reviewed, an outcome was decided in 134 cases; of which, 67.9% were successful for the claimant, resulting in compensation being paid. The most common reasons for successful claims were treatment complications (47 cases) and delay or failure of diagnosis (22 cases). Nerve and/or vocal cord damage and hypoparathyroidism were cited in 12 and 3 cases, respectively. Common specialties involved in successful claims were general surgery, ENT and endocrinology. The median (range) costs paid for compensation were £50,701.35 (£189.00 to £4.5 million). The median (interquartile range) time from incident to settlement was 1254 (992-1756) days. The number of claims (overall and successful) has reduced over the 14-year period, but there has been no change in the total cost per successful claim from 2002 to 2014 (p = 0.151).Conclusion: This overview demonstrates common causes and identifies trends in thyroid malpractice litigation in the UK, highlighting the significant costs incurred. The outcomes of the study will provide a basis to enable clinicians to avoid potential pitfalls and formulate guidelines to minimize risk.


Assuntos
Imperícia/estatística & dados numéricos , Medicina Estatal/legislação & jurisprudência , Doenças da Glândula Tireoide/epidemiologia , Compensação e Reparação/legislação & jurisprudência , Erros de Diagnóstico/legislação & jurisprudência , Erros de Diagnóstico/estatística & dados numéricos , Humanos , Imperícia/economia , Estudos Retrospectivos , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/terapia , Tempo para o Tratamento , Reino Unido/epidemiologia
6.
Br J Hosp Med (Lond) ; 80(7): 387-390, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31283388

RESUMO

The costs of litigation are large and increasing, to a level that places a drain on precious health-care resources and affects the way medicine is practised. This article examines whether a change to a no-fault legal system would lead to reduced costs and improved patient care.


Assuntos
Imperícia/economia , Imperícia/legislação & jurisprudência , Erros Médicos/economia , Erros Médicos/legislação & jurisprudência , Humanos , Responsabilidade Legal/economia , Procedimentos Ortopédicos/economia , Melhoria de Qualidade/organização & administração , Medicina Estatal/economia , Medicina Estatal/legislação & jurisprudência , Reino Unido , Ferimentos e Lesões/economia
7.
Am J Med ; 132(10): 1129-1132, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31150642

RESUMO

Although the exact sums can only be estimated, large amounts of money are wasted by the US health care system through fraud and by spending on tests, procedures, and treatments that are of no proven benefit. The adversarial fault-finding malpractice system siphons off large amounts of money from patients to lawyers and legal costs and is a deterrent to system improvement. While electronic records have the potential to improve care and lower costs through information sharing, their current implementation neither improves care nor lowers costs. If care is to be improved while costs are reduced, changes must be made in all these areas.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/normas , Registros Eletrônicos de Saúde , Fraude , Custos de Cuidados de Saúde , Imperícia , Registros Eletrônicos de Saúde/normas , Fraude/economia , Humanos , Imperícia/economia , Estados Unidos
8.
Obstet Gynecol Clin North Am ; 46(2): 247-255, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056127

RESUMO

Disclosure of medical errors and adverse outcomes is expected by regulatory agencies and society as a whole. Disclosure should occur in a systematic way that ensures honesty and transparency regarding the care that has been provided. It is often appropriate to seek professional help from Clinical Risk Management to assist with disclosure of any serious safety event that resulted in harm. Disclosure of medical errors facilitates efforts to prevent recurrence of safety events.


Assuntos
Erros Médicos , Revelação da Verdade , Atitude do Pessoal de Saúde , Empatia , Feminino , Ginecologia , Custos de Cuidados de Saúde/tendências , Humanos , Recém-Nascido , Sulfato de Magnésio/administração & dosagem , Imperícia/economia , Imperícia/legislação & jurisprudência , Erros Médicos/economia , Erros Médicos/legislação & jurisprudência , Obstetrícia , Pré-Eclâmpsia/terapia , Gravidez , Gestão de Riscos
9.
J Bone Joint Surg Am ; 101(7): e27, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30946201

RESUMO

BACKGROUND: Poor clinical outcomes and adverse events following orthopaedic trauma are common, which may lead to litigation. To our knowledge, factors associated with litigation following fracture care have not previously been evaluated. METHODS: A retrospective review of fracture-related malpractice lawsuits from 1988 to 2015 was completed utilizing VerdictSearch (ALM Media Properties), a medicolegal database. Defendant and plaintiff characteristics along with fracture type, allegations, litigation outcomes, and the association of case characteristics with outcomes were analyzed. RESULTS: A total of 561 cases were evaluated; 360 cases were excluded, resulting in a total of 201 cases that were analyzed in detail. The mean age of the plaintiff was 43.1 years (standard deviation [SD],19.4 years). Twenty-four fracture types were represented among the analyzed cases. The most common fractures were of the radius (44), the femur (32), the tibia (30), the ulna (29), the humerus (26), the spine (24), the hip (17), and the fibula (15). Overall, 129 (64.2%) cases resulted in a defense verdict, 41 (20.4%) cases resulted in a plaintiff verdict, and 31 (15.4%) cases resulted in a settlement. For plaintiff verdicts, the mean indemnity payment was $3,778,657 (median, $753,057; range, $89,943 to $27,926,311). For settlements, the mean indemnity payment was $1,097,439 (median, $547,935; range, $103,541 to $9,445,113). The mean indemnity for plaintiff verdicts was significantly greater than the mean indemnity for settlements (p = 0.03). The presence of a neurological deficit was associated with a significantly greater likelihood of a favorable outcome for the plaintiff (52.8% for plaintiffs with neurological deficit versus 32.1% for plaintiffs without neurological deficit; p = 0.019). CONCLUSIONS: This study examined malpractice litigation following traumatic orthopaedic injuries. In cases with decisions for the plaintiff, indemnity payments were on average more than $2.5 million larger than payments for settlements. In fracture cases with neurological deficit, malpractice cases were more likely to result in a favorable outcome for the plaintiff.


Assuntos
Fraturas Ósseas/cirurgia , Imperícia/economia , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Erros Médicos/economia , Complicações Pós-Operatórias/economia , Estados Unidos , Adulto Jovem
11.
Health Care Manag (Frederick) ; 38(2): 109-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30920990

RESUMO

States have engaged in medical malpractice litigation reforms over the past 30 years to reduce malpractice insurance premiums, increase the supply of physicians, reduce the cost of health care, and increase efficiency. These reforms have included caps on noneconomic damages and legal procedural changes. Despite these reforms, health care costs in the United States remain among the highest in the world, provider shortages remain, and defensive medicine practices persist. The purpose of this study was to determine how successful traditional medical malpractice reforms have been at controlling medical costs, decreasing defensive medicine practices, lowering malpractice premiums, and reducing the frequency of medical malpractice litigation. Research has shown that direct reforms and aggressive damage caps have had the most significant impact on lowering malpractice premiums and increasing physician supply. Out of the metrics that were improved by malpractice reforms, similar improvements were shown because of quality reform measures. While traditional tort reforms have shown some targeted improvement, large-scale, system-wide change has not been realized, and thus it is time to consider alternative reforms.


Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Responsabilidade Legal/economia , Imperícia/economia , Imperícia/legislação & jurisprudência , Controle de Custos , Medicina Defensiva/economia , Custos de Cuidados de Saúde , Humanos , Médicos/provisão & distribução , Estados Unidos
12.
Anesth Analg ; 129(1): 255-262, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30925562

RESUMO

BACKGROUND: Closed malpractice claim studies allow a review of rare but often severe complications, yielding useful insight into improving patient safety and decreasing practitioner liability. METHODS: This retrospective observational study of pain medicine malpractice claims utilizes the Controlled Risk Insurance Company Comparative Benchmarking System database, which contains nearly 400,000 malpractice claims drawn from >400 academic and community medical centers. The Controlled Risk Insurance Company Comparative Benchmarking System database was queried for January 1, 2009 through December 31, 2016, for cases with pain medicine as the primary service. Cases involving outpatient interventional pain management were identified. Controlled Risk Insurance Company-coded data fields and the narrative summaries were reviewed by the study authors. RESULTS: A total of 126 closed claims were identified. Forty-one claims resulted in payments to the plaintiffs, with a median payment of $175,000 (range, $2600-$2,950,000). Lumbar interlaminar epidural steroid injections were the most common procedures associated with claims (n = 34), followed by cervical interlaminar epidural steroid injections (n = 31) and trigger point injections (n = 13). The most common alleged injuring events were an improper performance of a procedure (n = 38); alleged nonsterile technique (n = 17); unintentional dural puncture (n = 13); needle misdirected to the spinal cord (n = 11); and needle misdirected to the lung (n = 10). The most common alleged outcomes were worsening pain (n = 26); spinal cord infarct (n = 16); epidural hematoma (n = 9); soft-tissue infection (n = 9); postdural puncture headache (n = 9); and pneumothorax (n = 9). According to the Controlled Risk Insurance Company proprietary contributing factor system, perceived deficits in technical skill were present in 83% of claims. CONCLUSIONS: Epidural steroid injections are among the most commonly performed interventional pain procedures and, while a familiar procedure to pain management practitioners, may result in significant neurological injury. Trigger point injections, while generally considered safe, may result in pneumothorax or injury to other deep structures. Ultimately, the efforts to minimize practitioner liability and patient harm, like the claims themselves, will be multifactorial. Best outcomes will likely come from continued robust training in procedural skills, attention paid to published best practice recommendations, documentation that includes an inclusive consent discussion, and thoughtful patient selection. Limitations for this study are that closed claim data do not cover all complications that occur and skew toward more severe complications. In addition, the data from Controlled Risk Insurance Company Comparative Benchmarking System cannot be independently verified.


Assuntos
Assistência Ambulatorial/legislação & jurisprudência , Analgesia Epidural/efeitos adversos , Analgésicos/efeitos adversos , Compensação e Reparação/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Manejo da Dor/efeitos adversos , Dor/prevenção & controle , Segurança do Paciente/legislação & jurisprudência , Adolescente , Adulto , Idoso , Analgésicos/administração & dosagem , Bases de Dados Factuais , Feminino , Humanos , Injeções , Seguro de Responsabilidade Civil/economia , Masculino , Imperícia/economia , Pessoa de Meia-Idade , Segurança do Paciente/economia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
13.
Ann Surg ; 269(5): 785-791, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30601246

RESUMO

OBJECTIVE: We aimed to study the contributing factors and costs of malpractice claims involving the surgical management of benign biliary disease given the emotional, physical, and financial toll of these claims on patients, providers, and the healthcare system. SUMMARY BACKGROUND DATA: Cholecystectomy complications carry significant morbidity and rank among the leading sources of surgical malpractice claims. METHODS: Using the CRICO Strategies' Comparative Benchmarking System database, representing approximately 30% of all paid and unpaid malpractice claims in the United States, 4081 closed claims filed against general surgeons from 1995 to 2015 were reviewed to isolate 745 cholecystectomy-related claims. A multivariable model was used to determine factors associated with claim outcome. RESULTS: The most common associated complications included bile duct injury (n = 397), bowel perforation (n = 96), and hemorrhage (n = 78). Bile duct injuries were recognized intraoperatively only 19% of the time and required biliary reconstruction surgery 77% of the time. The total cost for all claims over the study period was over $128 M and the median time from event to case close was over 3 years. 40% of claims resulted in patient payout; of these, most claims were settled out of court and the median cost per claim was $264,650. For the 60% of claims not resulting in patient payout, most cases were denied, dropped, or dismissed, yet still averaged over $15,000 per claim in legal and administrative fees. On multivariable analysis, bile duct injury, bowel perforation, and high clinical severity were associated with patient payout, while a resident or fellow being named in a claim was negatively associated with patient payout (P < 0.05). CONCLUSION: Cholecystectomy-related claims are costly and time-consuming. Strategies that reduce the risk and aid in recognition of cholecystectomy complications, as well as advance support of patients and families after poor outcomes, may improve clinical care and reduce claim burden.


Assuntos
Colecistectomia , Doenças da Vesícula Biliar/cirurgia , Imperícia/economia , Imperícia/estatística & dados numéricos , Complicações Pós-Operatórias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Estados Unidos
15.
Minerva Chir ; 74(2): 160-164, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30037174

RESUMO

Although mortality rates attributable to colon cancer have significantly improved over the past decades, it is still one of the leading causes of death in the USA. As newer technology and surgical techniques and concepts are being introduced, substantial confusion and dissenting opinions have come into fray as well. Naturally, different practice patterns emerged in Asia, Western Europe as well as in the USA. In this special article, we focus on the right colon and examine the unique challenges and oddities of practicing academic colorectal surgery in the New York metropolitan area.


Assuntos
Colectomia/legislação & jurisprudência , Neoplasias do Colo/cirurgia , Cirurgia Colorretal/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias do Colo/irrigação sanguínea , Neoplasias do Colo/patologia , Cirurgia Colorretal/efeitos adversos , Humanos , Consentimento Livre e Esclarecido , Responsabilidade Legal/economia , Excisão de Linfonodo/normas , Imperícia/economia , Metáfora , New York , Cidade de Nova Iorque , Padrões de Prática Médica/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Br J Community Nurs ; 24(1): 35-37, 2019 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-30589592

RESUMO

The cost of negligence claims in the NHS continues to rise, with NHS England alone paying out some £1.75 billion in compensation last year ( NHS Resolution, 2018 ). Negligence law concerns liability for careless acts or omissions that harm another in breach of a duty of care ( Sidaway v Bethlem Royal Hospital [1985] ). To minimise the risk of liability it is essential that district nurses are aware of the circumstances that give rise to a duty of care and the standard expected of them in discharging their duty.


Assuntos
Imperícia/legislação & jurisprudência , Enfermagem , Padrão de Cuidado/legislação & jurisprudência , Enfermagem em Saúde Comunitária , Humanos , Imperícia/economia , Medicina Estatal , Reino Unido
18.
G Ital Nefrol ; 35(6)2018 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-30550044

RESUMO

The article deals with the regulatory and jurisprudential evolution of medical criminal responsibility from the 70s to the Gelli-Bianco law of 2017. Subsequently it winds through the contribution of the last important judgments of the subject up to the decisions of the Supreme Court with United Sections of 2018, finally to conclude with an economic analysis on the increasement of the legal disputes registered in recent years.


Assuntos
Crime/legislação & jurisprudência , Legislação Médica , Responsabilidade Legal , Crime/economia , Crime/história , História do Século XX , História do Século XXI , Itália , Legislação Médica/economia , Legislação Médica/história , Legislação Médica/tendências , Responsabilidade Legal/economia , Imperícia/economia , Imperícia/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Punição
19.
Saudi Med J ; 39(11): 1075-1081, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30397705

RESUMO

Efficient process of litigation of medical errors is a key to ensure fair, speedy, and accessible justice system. The conditions of establishing medical negligence are similar in both legal systems. These conditions include the duty of care, breach of that duty of care, the damages, and establishing causation. A culture of litigation and compensation is growing in the United Kingdom and Kingdom of Saudi Arabia; however the cost of medical claims and awarded compensations are much more in the United Kingdom compared to Kingdom of Saudi Arabia. In Kingdom of Saudi Arabia, there is a need for more transparency in the documentation and publication of litigated medical errors. In addition, there is a need to introduce interventions to shorten the duration of litigation in both legal systems. Financial caps on awarded compensation and caps on expert and legal fees are potential strategies to control the cost of medical errors which seems to work well in the Saudi model.


Assuntos
Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Dano ao Paciente/legislação & jurisprudência , Causalidade , Compensação e Reparação/legislação & jurisprudência , Documentação , Humanos , Responsabilidade Legal , Imperícia/economia , Erros Médicos/economia , Dano ao Paciente/economia , Arábia Saudita , Reino Unido
20.
Health Aff (Millwood) ; 37(11): 1845-1852, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30395493

RESUMO

Communication-and-resolution programs (CRPs) are intended to promote accountability, transparency, and learning after adverse events. In this article we address five key challenges to the programs' future success: implementation fidelity, the evidence base for CRPs and their link to patient safety, fair compensation of harmed patients, alignment of CRP design with participants' needs, and public policy on CRPs. While the field has arrived at an understanding of the core communication-and-resolution practices, limited adherence fuels skepticism that programs are meeting the needs of patients and families who have been injured by care or improving patient safety. Adherence to communication-and-resolution practices could be enhanced by adopting measures of CRP quality and implementing programs in a comprehensive, principled, and systematic manner. Of particular importance is offering fair compensation to patients in CRPs and supporting their right to attorney representation. There is evidence that the use of CRPs reduces liability costs, but research on other outcomes is limited. Additional research is especially needed on the links between CRPs and quality and on the programs' alignment with patients' and families' needs. By honoring principles of transparency, quality improvement, and patient and family empowerment, organizations can use their CRPs to help revitalize the medical profession.


Assuntos
Comunicação , Compensação e Reparação/legislação & jurisprudência , Hospitais/normas , Erros Médicos/legislação & jurisprudência , Segurança do Paciente/normas , Humanos , Responsabilidade Legal/economia , Imperícia/economia , Imperícia/estatística & dados numéricos , Negociação
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