Medical malpractice claims in Hepatology: Rates, Reasons, and Results.
Medical malpractice claims in Hepatology: Rates, Reasons, and Results.
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DOI：
10.1097/hc9.0000000000000122
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发表时间：
2023-05-01
影响因子：
5.1
通讯作者：
Tapper, Elliot B.
中科院分区：
文献类型：
--
作者：
Holman, Alexis;McKeown, Ellen;Quinn, Moira;Parikh, Neehar D.;Tapper, Elliot B.
临床医生积极为慢性肝病患者提供安全、高质量的护理。这包括避免诉讼的愿望。关于慢性肝病的法医学风险的实际来源的数据有限。我们对一家国家责任保险公司(Candello)进行了审查，并对我们机构的责任索赔登记进行了额外的细粒度分析。我们纳入了2012至2021年间与慢性肝病相关的已结案病例。我们确定了研究期间独特的肝硬变患者或移植护理患者的法律索赔比率。本地数据库：我们检索了39项索赔，其中15项涉及非肝硬化性慢性肝病患者，13项涉及肝硬变(0.06%)，11项涉及接受移植的患者(0.6%)。大多数索赔涉及围手术期并发症。其他不良反应包括预防性输注血浆的不良反应、药物引起的HE和跌倒/骨折。在102,575起(0.09%)的索赔中，我们发现了94起与肝病有关的索赔。总体而言，56%涉及与诊断相关的问题(未能/延迟订购诊断测试，未能理解和协调症状/体征或结果，或对诊断研究的误解)。22%的病例涉及提供者之间以及提供者与患者之间的沟通不畅。与患者行为相关的因素(不遵守预定的预约、治疗或诊断测试)在20%的病例中被考虑在内。在7%的病例中，治疗的选择或管理起了作用。与技术技能(4%)、内务人员监督(3%)或周末/假期护理(1%)有关的病例很少。51份(55%)的索赔涉及肝癌。我们提供了肝病医疗事故索赔的比率和原因。
Clinicians are motivated to provide safe, high-quality care to patients with chronic liver disease. This includes the desire to avoid litigation. Data are limited regarding the actual sources of medicolegal risk in chronic liver disease. We conducted a review of a national liability insurer (Candello) with an additional granular analysis of our institution’s registry of liability claims. We included closed cases involving chronic liver disease-related encounters between 2012 and 2021. We determined rates of legal claims from a denominator of unique patients with cirrhosis or transplant care seen over the study period. Local database: We retrieved 39 claims of which 15 involved patients with non-cirrhotic chronic liver disease, 13 involved cirrhosis (0.06% incidence), and 11 involved patients who underwent transplantation (0.6% incidence). Most claims involved periprocedural complications. Others included adverse reactions to prophylactic plasma transfusion, medication-induced HE, and falls/fractures. We found 94 claims related to liver disease out of 102,575 (0.09%) total claims. Overall, 56% involved diagnosis-related issues (failure/delay in ordering a diagnostic test, failure to appreciate and reconcile a symptom/sign or result, or the misinterpretation of a diagnostic study). Miscommunication between providers and between providers and patients was implicated in 22% of cases. Patient behavior-related factors (nonadherence with scheduled appointments, treatments, or diagnostic testing) factored in 20% of cases. Selection or the management of therapy played a role in 7% of cases. Very rarely were cases associated with technical skill (4%), house staff supervision (3%), or weekend/holiday care (1%). Fifty-one (55%) claims involved HCC. We provide the rates and reasons for medical malpractice claims in hepatology.