Rogers S, Gawande A, Kwaan M, Puopolo AL, Yoon C, Studdert D; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 3915.
Brigham and Women's Hospital, Department of Surgert, 75 Francis Street, Boston, MA 02115 Tel. (617) 732-8042 Fax (617) 732-6047
RESEARCH OBJECTIVE: Little is known about the relative importance of the factors that contribute to surgical errors. We analyzed medical malpractice insurance files to determine whether in-depth information from this source could shed light on factors that frequently contribute to surgical error. STUDY DESIGN: We identified 395 surgical malpractice claims closed between 1985 and 2003 at four liability insurance companies. Claims were eligible for the sample if their allegation related to a surgical condition, defined as a non-obstetric condition involving operative treatment. A trained surgeon-reviewer examined the medical chart and malpractice insurance file for each claim. Claims judged to involve an adverse outcome (defined as an injury from medical care, not disease, resulting in death, disability, prolonged hospital stay, or an alteration in care) and an error (according to the Institute of Medicines definition of that term) were triaged for a detailed review of causal factors. For simplicity, we refer hereinafter to claims that involved both an adverse outcome and an error as errors. Our analysis is descriptive. We describe the characteristics of the errors, and the factors that contributed to them. POPULATION STUDIED: 395 malpractice claims in which the plaintiff alleged a surgical error, sampled from 4 liability insurance companies. PRINCIPAL FINDINGS: Nearly two thirds (n=258) of the 395 sampled claims involved errors in surgical care. Forty-four percent of the errors led to permanent disability; 23% resulted in death. Seventy-five percent of errors occurred in the intraoperative phase of surgical care, 25% in the preoperative phase, and 35% in the postoperative phase. In 61% of errors, more than one clinician contributed to error, and in 42% trainees were involved. Systems factors played a role in 86% of errors. The systems factors that most frequently contributed to errors were inexperience/lack of technical competence (59% of errors), communication breakdowns (24%), and lack of trainee supervision (18%). Claims involving technical errors (54% of all errors identified) were significantly more likely (p<0.05) than claims without technical errors to involve breakdowns in multiple phases of care (36% vs. 24%), and have inexperience (51% vs. 30%) and patient-related factors (54% vs. 33%) identified as causal factors. On the other hand, technical errors were less likely to involve communication breakdown (16% vs. 33%, p<0.05). CONCLUSIONS: Systems factors play a critical role in surgical errors of all types, including errors due to technical problems. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Rigorous analysis of closed malpractice claims provides insights into the nature and etiology of surgical error, and may facilitate the design of targeted interventions to reduce such errors.
Publication Types:
Keywords:
- Communication
- Humans
- Insurance, Liability
- Malpractice
- Medical Errors
- Research
- Urology
- economics
- hsrmtgs
UI: 103623378
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