Patient Safety

3 Things You Want to Know About Hospital Medical Malpractice

In a poster presentation at this year’s annual of meeting of the American Society of Anesthesiologists, researchers looked at anesthesia-related physician malpractice claims between 2005 and 2013.

#1 – Medical Malpractice Claims are Decreasing

In reviewing the 2,408 medical malpractice claims, the researchers found that malpractice claims are decreasing – inpatient claims decreased 45.5 percent from 2005 to 2013 (5.1 percent per year) and outpatient claims decreased 24.3 percent during that period (2.7 percent per year).

Image source: https://pixabay.com/en/operation-respiratory-mask-540598/

Image source: https://pixabay.com/en/operation-respiratory-mask-540598/

In commenting on this finding, lead researcher Richard J. Kelly, MD, JD, MPH, FCLM, an anesthesiologist from the University of California, Irvine School of Medicine, said:

Since 2005, overall spending on anesthesia-related claims has decreased by 41.4% ($83.3 million), which is great. It looks like we’re doing something right.

What might have caused the decrease?

Paul Picton, MD, MRCP, FRCA, associate professor of anesthesiology, University of Michigan, has suggested that hospitals have become more savvy regarding risk management.

#2 – Outpatient Medical Malpractice Claims are Rising

Of the 2,408 medical malpractice claims from 2005 to 2013, 76.5 percent occurred in inpatient settings and 23.5 percent occurred in outpatient settings.

Dr. Kelly observed:

Due to increased outpatient utilization, the proportion of claims for outpatients has actually increased as compared to inpatients

Could the increase in outpatient claims be due to differences in medical standards from those in inpatient settings?

In “Medical standards of care and the Joan Rivers death”, the differences in anesthesia medical standards of care were discussed:

What is instructive in terms of gained knowledge in the Joan Rivers’ death is the differing patient safety measures in place by the application of standards when a sedative is delivered to the patient.

The AAAASF standard would have monitored for oxygenation by pulse oximeter, which measures the amount of oxygen in blood. Measuring oxygenation provides a very late indicator of hypoventilation, or ineffective breathing. In other words, there would have been a delay in the detection of low blood oxygenation by pulse oximeter.

The ASA standards provide an extra level of patient safety by requiring that the adequacy of ventilation be monitored in addition to oxygenation. The ASA standards therefore call for the “continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide”.

#3 – Medical Malpractice Claims Usually Are Related to Death or Major Injury

Of the claims paid, death or major injury was the usual patient outcome – occurring 69.6 percent of the time in inpatient claims and 63.7 percent in outpatient claims.

This finding underscores the dangers related to the use of opioids. As The Joint Commission stated in Sentinel Event Alert #49 “Safe use of opioids in hospitals”:

While opioid use is generally safe for most patients, opioid analgesics may be associated with adverse effects, the most serious effect being respiratory depression, which is generally preceded by sedation.

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