부산대학교 도서관

INTRODUCTION Patient safety and Medical Professional Liability (MPL) are top priorities in everyday medical practice. High rates of claims for alleged malpractice in the surgical medical field have been reported and it also affects Anaesthesiology, Resuscitation and Pain Management speciality, which is responsible for the sixth highest number of claims in Catalonia. The percentage of compensated cases is slightly higher than the average, and its cost in terms of average compensation is double that of all combined specialties. HYPOTHESIS AND OBJECTIVES Anesthesiology, Resuscitation and Pain Management has an average frequency of claims for MPL, the most recurring issue was airway management and neurological injury. The aim of this study is trying to determine how frequent they are in Anesthesiology, regarding MPL, and identifying areas of care intervention with the highest amount of claims. To detect defects in common practice and guiding the development of specific clinical measures was also an objective. RESULTS From all the specialties registered in Professional Liability Department (PLD) of the Council of Medical Colleges of Catalonia database, from 2000 to 2013, out of the 4,402 medical claims submitted, 154 belonged to Anaesthesiology, which represents the 3.4% of the total. Anaesthesiology has a claim frequency of 11 cases/per annum. The MPL rate is 35.7%. Claims continue to be directed predominantly to a single Anaesthesiologist, mostly male. The profile of the patient involved in a claim is predominantly middle aged, previously healthy with no predominant sex. The type of anaesthetic act with higher MPL is General Anaesthesia (39.5 %). Regional Anaesthesia and, in particular, Epidural Anaesthesia, has a high MPL rate (39.1%). Patient information procedure is poorly documented in 51.3% of cases, which correlates positively and significantly (p=0.000) with the concurrence of MPL. According to the NPSA scale, adverse events categorised as ‘severe’ and ‘exitus’, represent 49.3 % of total claims. Most frequently claims reported are: dental injuries (27,3 %), central nervous system and anoxia. Exitus (14.9 %) is mainly caused by haemorrhage and cardiac etiologies (39.4 % of deaths). Claims are filed in average one year after the adverse event occurred and require an average period of almost three years until it reaches its final resolution (2.75 years). The shorter the time elapsed between the adverse event and the claim, the more likely to have an MPL with statistical significance. The majority of claims were settled out of court with statistical significance. CONCLUSION Anaesthesiology, Resuscitation and Pain Management is a specialty with an average frequency of claims, with an increased risk due to the high level of professional responsibility and high compensatory amounts. Airway management (intubation) and the related outcomes have significant impact on these claims. The second most frequent claims are those involving central and peripheral nervous system injuries. Patient’s information process (and so patient’s autonomy) is deficient and can lead into consequences of MPL.