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1.
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
2.
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
3.
Psychiatr Prax ; 46(8): 460-467, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31683336

RESUMO

OBJECTIVE: A pilot study was conducted to test a newly developed inventory for the assessment of malpractice in psychotherapy and its consequences. We aimed to examine the frequency of boundary crossings and violations in the context of psychotherapy from a patient's perspective and the resulting burden as well as to identify potential predictors. METHODS: Data assessment was realized in an online-based survey. The final sample existed of N  = 165 patients who underwent prior psychotherapeutic treatment. RESULTS: Patients reported M = 16.21 events which can be interpreted in terms of malpractice resulting in a mediocre level of distress. While malpractice summarized as "inadequate use of diagnostics/techniques" was reported most frequently, sexual boundary violations were associated with the highest levels of distress. CONCLUSION: The results demonstrate the need of a differential and systematic assessment of malpractice in psychotherapy. The new inventory especially seems to be suited for research purposes.


Assuntos
Imperícia , Relações Médico-Paciente , Psicoterapia , Alemanha , Humanos , Imperícia/estatística & dados numéricos , Projetos Piloto , Psicoterapia/legislação & jurisprudência , Delitos Sexuais/legislação & jurisprudência , Comportamento Sexual
4.
AANA J ; 87(2): 124-130, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31587725

RESUMO

More than 200 million adults have noncardiac surgery worldwide every year. Anesthesia closed claims databases allow anesthesia providers to critically examine adverse outcomes that occur during an anesthetic or immediately following the administration of anesthesia, to aid in improving patient care. A qualitative analysis of 34 closed malpractice claims with a cardiac-related event was conducted to determine common themes. Five common themes emerged: preanesthetic evaluation, normalization of deviance, medications, hemorrhage, and knowledge deficit/failed clinical reasoning.


Assuntos
Anestesia/efeitos adversos , Imperícia/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Enfermeiras Anestesistas , Fatores de Risco , Sociedades de Enfermagem , Estados Unidos
5.
Anesthesiology ; 131(4): 818-829, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31584884

RESUMO

BACKGROUND: Difficult or failed intubation is a major contributor to morbidity for patients and liability for anesthesiologists. Updated difficult airway management guidelines and incorporation of new airway devices into practice may have affected patient outcomes. The authors therefore compared recent malpractice claims related to difficult tracheal intubation to older claims using the Anesthesia Closed Claims Project database. METHODS: Claims with difficult tracheal intubation as the primary damaging event occurring in the years 2000 to 2012 (n = 102) were compared to difficult tracheal intubation claims from 1993 to 1999 (n = 93). Difficult intubation claims from 2000 to 2012 were evaluated for preoperative predictors and appropriateness of airway management. RESULTS: Patients in 2000 to 2012 difficult intubation claims were sicker (78% American Society of Anesthesiologists [ASA] Physical Status III to V; n = 78 of 102) and had more emergency procedures (37%; n = 37 of 102) compared to patients in 1993 to 1999 claims (47% ASA Physical Status III to V; n = 36 of 93; P < 0.001 and 22% emergency; n = 19 of 93; P = 0.025). More difficult tracheal intubation events occurred in nonperioperative locations in 2000 to 2012 than 1993 to 1999 (23%; n = 23 of 102 vs. 10%; n = 10 of 93; P = 0.035). Outcomes differed between time periods (P < 0.001), with a higher proportion of death in 2000 to 2012 claims (73%; n = 74 of 102 vs. 42%; n = 39 of 93 in 1993 to 1999 claims; P < 0.001 adjusted for multiple testing). In 2000 to 2012 claims, preoperative predictors of difficult tracheal intubation were present in 76% (78 of 102). In the 97 claims with sufficient information for assessment, inappropriate airway management occurred in 73% (71 of 97; κ = 0.44 to 0.66). A "can't intubate, can't oxygenate" emergency occurred in 80 claims with delayed surgical airway in more than one third (39%; n = 31 of 80). CONCLUSIONS: Outcomes remained poor in recent malpractice claims related to difficult tracheal intubation. Inadequate airway planning and judgment errors were contributors to patient harm. Our results emphasize the need to improve both practitioner skills and systems response when difficult or failed tracheal intubation is encountered.


Assuntos
Anestesiologistas/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/estatística & dados numéricos , Imperícia/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
6.
J Forensic Leg Med ; 68: 101863, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31494526

RESUMO

INTRODUCTION: Dental malpractice/negligence litigations against dentists in India is not widely studied. The aim of this study is to report the Indian dentist related litigation landscape in consumer redressal forum (CRF) and to understand more of the nature of the same. MATERIAL AND METHOD: 111 cases of judgments of dental malpractice in Indian CRF were collected. Useful information was extracted, reported in a grid and statistically analyzed. Data was compared by claim, specialty, treatment offered, days lapsed and compensation awarded. P ≤ 0.05 was taken as statistically significant. RESULTS: In all, 44 (39.63%) dentists were found guilty. Thirty dentists had produced at least one evidence in their favor. Among them, 23 outcomes were in dentist's favor.(P = 0.02) The mean wait for final judgment was 1945 ±â€¯1286(193-6762) days. The mean compensation claimed was INR 577287 ±â€¯905898. Presence of evidence (dentists/patients) had an impact on the days to reach a judgment as well as compensation. CONCLUSION: Indian dental litigation landscape CRF has been described for the first time. We identified that CRF litigation of dental malpractice are few, as compared to number of procedures performed in India. Oral surgical procedures were often involved and 40% of instances, dentists were guilty and mean compensation awarded was INR 103998 ±â€¯158976.


Assuntos
Odontólogos/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Compensação e Reparação/legislação & jurisprudência , Odontólogos/estatística & dados numéricos , Odontologia Baseada em Evidências/legislação & jurisprudência , Odontologia Baseada em Evidências/estatística & dados numéricos , Prova Pericial/legislação & jurisprudência , Prova Pericial/estatística & dados numéricos , Humanos , Índia , Imperícia/estatística & dados numéricos , Procedimentos Cirúrgicos Bucais/legislação & jurisprudência , Procedimentos Cirúrgicos Bucais/estatística & dados numéricos
7.
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
8.
Eur Arch Otorhinolaryngol ; 276(10): 2947-2951, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31321501

RESUMO

PURPOSE: The purpose of this study was to examine the malpractice litigations pertaining to otorhinolaryngology in Japan. METHODS: A retrospective review was undertaken of cases tried in the Japanese civil court system during the 26-year period from 1990 to 2015 as identified in a computerized legal database. Data including patient demographics, disease, chief allegations, court's decisions, and the year decision was made were collected and analyzed. Patients' chief allegations were assigned to one of the five categories: delayed diagnosis, complication during diagnostic procedure, inappropriate treatment, complication during treatment procedure, or lack of informed consent. RESULTS: Thirty-one malpractice litigations were identified. Eight (26%) malpractice litigations pertained to tumors, 1 (3%) to a tumor-like lesion, 14 (45%) to inflammation, and 8 (26%) to others. Among the patients' chief allegations, inappropriate treatment and complication during treatment procedure were the most frequent [11 (36%) for each], followed by delayed diagnosis [6 (19%)], complication during diagnostic procedure [2 (6%)], and lack of informed consent [1 (3%)]. CONCLUSION: These data may aid in the design of risk-prevention strategies to be used by otorhinolaryngologists.


Assuntos
Imperícia , Otolaringologia , Gestão de Riscos/normas , Humanos , Japão , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Otolaringologia/legislação & jurisprudência , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Estudos Retrospectivos
9.
Semin Diagn Pathol ; 36(5): 366-371, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351825

RESUMO

Medicolegal liability is an issue of concern for all physicians, including pathologists. Identification of the key clinical issues that tend to lead to medical malpractice litigation, as well as the settlement values for such claims, can be useful for prospective risk management. This review analyzes medical malpractice claims filed in state and federal courts as published in legal databases. Additionally, this review also analyzes the reported settlement values for such claims.


Assuntos
Laboratórios , Imperícia/estatística & dados numéricos , Patologia Clínica , Padrão de Cuidado , Humanos , Inquéritos e Questionários
10.
J Forensic Leg Med ; 67: 1-6, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31352158

RESUMO

OBJECTIVES: This study aims to extend the current understanding of violence against health professionals and facilities in China, with data from an authoritative, national-representative, but under-researched data source - litigation records, and discuss implications for developing violence prevention strategies. DESIGN: We collected all legal cases relevant to violence against health professionals and facilities from criminal ligation records released by the Supreme Court of China from 2010 to 2016. MAIN OUTCOME MEASURES: (i) Characteristics of perpetrators: gender, age, education, occupation, history of mental illness and alcohol; (ii) characteristics of victims: medical specialization, location, type of violence; (iii) outcome of treatment. RESULTS: 140 cases were collected for analysis. Beating, pushing, verbal abuse, threatening, burning mock paper money, placing a corpse in the hospital, hanging banners, blocking hospital gates and doors, and smashing hospital property were the most frequently reported types of violence. Specifically following patient deaths, the interval between a patient's death and violence by the patient's families and friends was short, with 51% happening on the same day. CONCLUSIONS: Our study provides a comprehensive overview of violence against health professionals and facilities in China, which can be used to inform the development of prevention strategies.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Intoxicação Alcoólica/epidemiologia , China/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Criminosos/estatística & dados numéricos , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Imperícia/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Distribuição por Sexo , Violência no Trabalho/legislação & jurisprudência , Adulto Jovem
11.
J Forensic Leg Med ; 66: 44-49, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220788

RESUMO

BACKGROUND: Today even low incidence of complications for mothers or neonates during pregnancy, delivery or postpartum is unacceptable to the public and can result in claims because of greater expectation from patients and an increase in media coverage. The present study was conducted to investigate the reasons for medical malpractice claims on maternal and neonatal impairment, which are achieved in Iranian Legal Medicine Organization councils. MATERIALS AND METHODS: The present cross-sectional and retrospective study used convenience sampling to collect data of total claims from 31 provinces archived in the supreme council of the ILMO in 2 years. In this article, the medical malpractice claims on maternal and neonatal impairment during pregnancy, labour, delivery and early postpartum were reported. The data were collected through a validated researcher-made checklist and were analyzed in SPSS 16. RESULTS: Among total of 299 cases of impairment, cerebral palsy (33.34%), Erb's palsy due to shoulder dystocia (24.24%) and Down Syndrome (24.24%) were the main confirmed causes of malpractice for neonatal impairment and Retained Surgical Mass (20.5%), Salpingectomy and/or Oophorectomy Related to EP (17.2%), Hysterectomy (17.2%) and Episiotomy Related complication (17.2%) were the main confirmed causes of malpractice for maternal impairment. CONCLUSION: Considering this fact that medical malpractice was confirmed in a large proportion of some preventable and important complications, therefore, results of this study can be used for developing educational programs for related healthcare providers to prevent those complications.


Assuntos
Parto Obstétrico/efeitos adversos , Imperícia/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adulto , Neuropatias do Plexo Braquial/epidemiologia , Paralisia Cerebral/epidemiologia , Estudos Transversais , Síndrome de Down/epidemiologia , Distocia/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia , Gravidez , Estudos Retrospectivos , Amostragem
12.
J Forensic Sci ; 64(6): 1693-1697, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31237698

RESUMO

The purpose of expert reports is to support the judge in his decisions, by providing technical information. However, it remains uncertain as to what extent the content of these reports is used, and if they are effectively associated with judicial decisions. The aim of this study was to perform a qualitative analysis of case reports in relation to the judicial decisions rendered in association with these reports, by determining the connection between causal nexus and aspects of fault. The case reports included lawsuits against dentists, issued by the Medical Justice Department of the State Court of Appeals of Rio Grande do Sul, Brazil, between 2010 and 2013. Comparing the percentage of agreement between case report and judicial decision, causal nexus was 79.9% and fault was 86.7%. The high percentages of agreement found in relation to fault and causal nexus highlight the relevance of expert reports in weighing the judge's decision.


Assuntos
Odontólogos , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Brasil , Humanos
13.
Medicine (Baltimore) ; 98(23): e15996, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169740

RESUMO

Drug-induced anaphylaxis (DIA) is a highly paradoxical disorder involving a fatal response to medicines prescribed for therapeutic purposes. This study aimed to improve the awareness on DIA and to prevent errors through an analysis of lawsuit judgments.Sentenced judgments involving DIA from 1998 to 2017 using the database of the Korean Supreme Court Judgment System were collected. General characteristics, results, and recognized negligence of DIA litigation cases were analyzed.Of 27 lawsuit cases included, antibiotics (n = 6, 22.2%), radiocontrast media (n = 6, 22.2%), and non-steroidal anti-inflammatory drugs (n = 5, 18.5%) were the most common drugs that had caused DIA. Cardiac arrest was reported in 23 cases (85.2%). The median time interval from drug administration to diagnosis and from diagnosis to cardiac arrest were 7 (interquartile range, IQR = 0-35) and 5 minutes (IQR = 0-33), respectively, suggesting insufficient time to cope with anaphylaxis. Consequently, either death (n = 18, 66.7%) or ischemic brain injury (n = 9, 33.3%) occurred in all cases. Violation of duty of care was recognized in 19 cases (70.4%) with median awarded amount of $106,060 (IQR = $70,296-$168,363). The recognized negligence included inadequate observation after drug administration (n = 6), delayed or missed epinephrine administration (n = 6), ignoring a history of allergy or drug hypersensitivity (n = 6), and prescription error (n = 5).It is necessary to improve the awareness on DIA, because making a trivial error in any process of history taking, drug prescription and administration, observation, and/or emergency treatment may have fatal consequences that can lead to indemnity.


Assuntos
Anafilaxia/induzido quimicamente , Hipersensibilidade a Drogas/complicações , Epinefrina/uso terapêutico , Imperícia/estatística & dados numéricos , Anafilaxia/tratamento farmacológico , Hipersensibilidade a Drogas/tratamento farmacológico , Humanos , República da Coreia
14.
Pediatr Emerg Care ; 35(6): 440-442, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31135686

RESUMO

Every pediatric emergency medicine provider will be involved in medical errors during their career and many will face the prospect of at least one malpractice lawsuit. These events can cause significant stress, including detrimental effects on providers' mental and physical health. This stress may also impact the provider's ability to care for future patients. In this installment of our series, "A Call to Restore Your Calling: Self-care of the Emergency Physician in the Face of Life-Changing Stress," we examine how medical errors and malpractice lawsuits may affect providers and how individuals and organizations can address these events.


Assuntos
Esgotamento Profissional/psicologia , Imperícia/legislação & jurisprudência , Erros Médicos/psicologia , Adaptação Psicológica , Esgotamento Profissional/complicações , Serviço Hospitalar de Emergência , Humanos , Imperícia/estatística & dados numéricos , Erros Médicos/legislação & jurisprudência , Erros Médicos/estatística & dados numéricos , Médicos/psicologia , Autocuidado/psicologia
16.
World J Gastroenterol ; 25(8): 1024-1030, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30833807

RESUMO

BACKGROUND: Tens of millions of gastrointestinal endoscopic procedures are performed every year in China, but the quality varies significantly and related factors are complex. Individual endoscopist- and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy. AIM: To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in mainland China. METHODS: Selected data on endoscopy experience, equipment, facility, qualification of endoscopists, and other relevant variables were collected from the National Database of Digestive Endoscopy of China. The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance. Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications. RESULTS: In 2012, gastroscopy/colonoscopy-related complications in mainland China included bleeding in 4,359 cases (0.02%) and perforation in 914 (0.003%). Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases (0.3%), bleeding in 2,151 (1.10%), perforation in 257 (0.13%) and biliary infection in 4,125 (2.11%). Moreover, 1,313 (5.0%) endoscopists encountered with medical malpractice, and 5,243 (20.0%) encountered with the disturbance from patients. The length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance. However, the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications. CONCLUSION: The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance. More comprehensive data are needed to establish quality-predictive models for endoscopic complications.


Assuntos
Doenças do Sistema Digestório/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Gastroenterologistas/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Qualidade da Assistência à Saúde/estatística & dados numéricos , China , Competência Clínica/estatística & dados numéricos , Doenças do Sistema Digestório/diagnóstico por imagem , Endoscopia Gastrointestinal/normas , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Gastroenterologistas/psicologia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Satisfação no Emprego , Imperícia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Controle de Qualidade , Qualidade da Assistência à Saúde/organização & administração , Carga de Trabalho
17.
Drug Alcohol Rev ; 38(4): 366-376, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30887600

RESUMO

INTRODUCTION AND AIMS: Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. DESIGN AND METHODS: Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. RESULTS: Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63-640.11) and pharmacists (AOR 85.59, 95% CI 5.08-1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80-97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01-0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50-157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24-20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1.52-41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. DISCUSSION AND CONCLUSIONS: Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs.


Assuntos
Imperícia/estatística & dados numéricos , Medicamentos sob Prescrição , Má Conduta Profissional/estatística & dados numéricos , Adulto , Analgésicos Opioides/efeitos adversos , Austrália , Feminino , Humanos , Hipnóticos e Sedativos , Masculino , Pessoa de Meia-Idade , Farmacêuticos , Médicos , Transtornos Relacionados ao Uso de Substâncias
18.
J Card Surg ; 34(5): 323-328, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30905069

RESUMO

BACKGROUND AND AIM: The feared prospect of involvement in malpractice litigation ultimately becomes a reality for many physicians in high-risk specialties such as cardiothoracic surgery. This study systematically analyzes malpractice claims by procedure type and alleged injury mechanism. METHODS: An extensive nation-wide database of medical malpractice claims was searched, and 140 involving cardiac procedures were identified. The primary reason for the lawsuit was classified as a periprocedural injury, postoperative mismanagement, failure to operate in a timely manner or at all, performing an unnecessary procedure, performing a procedure too soon, lack of informed consent, or patient abandonment. RESULTS: Cardiac surgeons were defendants in 47.8% of cases and cardiologists in 56.4%. Forty percent of cases involved coronary artery bypass grafting, valvular surgery, or both; 50% of these received defendant verdicts. The most common reason for the lawsuit was periprocedural injury, most frequently due to poor prosthetic valve fit/securement (23.1%) or surgical site infection (15.4%). For congenital cases, most lawsuits alleged periprocedural injury, with perfusion-related issues (cooling during circulatory arrest, failure to inform surgeon about poor oxygenation) cited in 37.5%. Cardiologists and cardiothoracic or vascular surgeons were codefendants in 14.3% of cases, most commonly coronary artery bypass grafting (40%) or cardiac catheterizations (25%). In all catheterization cases, the allegation against the surgeon was a failure to diagnose/treat the complication in a proper or timely manner. In postoperative mismanagement cases, bleeding/tamponade was the most common allegation category (31.8%). CONCLUSIONS: A careful review of cardiac surgical malpractice litigation can identify common contributory factors to adverse patient outcomes and catalyze practice improvement.


Assuntos
Procedimentos Cirúrgicos Cardíacos/legislação & jurisprudência , Jurisprudência , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Cirurgiões/legislação & jurisprudência , Idoso , Cateterismo Cardíaco , Ponte de Artéria Coronária/legislação & jurisprudência , Feminino , Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/legislação & jurisprudência , Hemorragia Pós-Operatória
19.
Otol Neurotol ; 40(3): 391-397, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30742599

RESUMO

OBJECTIVES: To analyze medical malpractice lawsuit trends pertaining to cases of vestibular schwannomas (VS). METHODS: Two major computerized legal databases (LexisNexis and WestLaw) were queried and reviewed for evaluation of all the US state and federal court records from civil trials alleging malpractice between 1976 and 2016. RESULTS: A total of 32 VS cases were identified. Allegations were divided into four categories: misdiagnosis/delayed diagnosis (47%), postoperative complications (44%), failure of informed consent or information sharing (16%), and other (3%). Postoperative complications included facial nerve paralysis, myocardial infarction, meningitis, and intracranial hemorrhage. Judgment amounts ranged from $300,000 to $2,000,000. The specialist type was specified for 24 of the 32 cases (75%): neurosurgeons (n = 9; 37%), neurotologists (n = 6; 25%), general otolaryngologists (n = 5; 21%), primary care physicians (n = 4; 17%), neurologists (n = 3; 12%), radiologists (n = 3; 12%), anesthesiologists (n = 2; 8%), radiation oncologists (n = 1; 4%), and general surgeon (n = 1; 4%). Of these 24 cases, (n = 9; 37%) two or more physicians were named as defendants in the lawsuit. CONCLUSIONS: Enhanced physician-patient communication, ensuring proper and adequate patient consent procedures, and proper documentation are good practices that may decrease the likelihood of lawsuits.


Assuntos
Imperícia/estatística & dados numéricos , Neuroma Acústico , Bases de Dados Factuais , Humanos , Estados Unidos
20.
Updates Surg ; 71(3): 463-469, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30783959

RESUMO

Complications following cholecystectomy may lead to malpractice litigation. Little research exists regarding cholecystectomy-related malpractice, the complications that lead to litigation, and the outcomes of such cases. This study is a retrospective analysis utilizing the legal database Verdictsearch (ALM Media Properties, LLC, New York, NY). Medical malpractice cases between July 2004 and November 2017 were identified using the search term "gallbladder." Case information was recorded, including patient information, medical details, trial outcome, and resulting payments. Of 46 cases examined, 39 went to trial with a favorable plaintiff (patient) verdict in 43% (20/46) and a favorable physician verdict in 41% (19/46) of the cases. Only 7% (3/46) of the cases resulted in a settlement, with 4% (2/26) concluding in mixed verdicts or arbitration. The mean plaintiff victory payment was $723,844 ± $1,119,457, while the mean settlement payment was $1,350,000 ± $563,471. Intraoperative care was the most frequently litigated phase of care (67%, 31/46 cases). Problematic visualization of the surgical field was the most frequent intraoperative allegation (67.7%, 21/46 cases). Cases of problematic visualization often resulted in favorable plaintiff trial victory (66.7% vs. 19% in defendant victory). Only 9.5% of the problematic visualization cases settled. Bile duct injuries accounted for 43.5% of the injuries (plaintiff victory rate 60.0%; mean payment $736,434 ± $1,365,424). In cholecystectomy litigation, allegations of problematic intraoperative visualization are both the most common allegation and the most likely to end in physician loss. Bile duct injuries remain the most frequent patient injury leading to cholecystectomy litigation.


Assuntos
Colecistectomia/legislação & jurisprudência , Imperícia , Colecistectomia/efeitos adversos , Feminino , Humanos , Masculino , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Erros Médicos/efeitos adversos , Erros Médicos/legislação & jurisprudência , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
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