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Medicolegal considerations
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Most physicians desire the best for their patients. More often than not, unfortunate maloccurrence is the nature of an adverse outcome rather than true medical malpractice. Physicians can benefit and avoid litigation by application of the principles of risk management.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
What level of risk would you mention?This depends on the individual patient and what he or she wants or needs to know.Adverse outcomes that may result from surgery, as well as those from not operating, must be identified.Risks include side effects, complications and failure of intervention.A patient must be told if surgery might result in a serious adverse outcome, even if the risk is very small (might affect their decision to consent). These are referred to as ‘material risks’ in the Montgomery versus Lanarkshire Health Board case.Patients also must be told about more common, less serious side effects, and what to do if they happen to the patient.
Risk and Patient Safety for the Legal Nurse Consultant
Published in Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson, Legal Nurse Consulting Principles and Practices, 2019
Bruce Edens, Andree Neddermeyer
Providing quality health care is not easy. The demands are round the clock and unpredictable with respect to volume and acuity. Often only a few staff are available to flawlessly execute simultaneous urgent salutary actions to restore health and save lives. There is always the specter of a bad outcome, patient/customer dissatisfaction, and an adverse outcome causing serious harm, disability, or death. The challenge is to deliver rapid, reliable, and reproducible quality care for the patients served and retain competent and engaged staff. Active interaction, training, education, and coaching of staff by senior leaders has tremendous power in developing situational awareness of risk. The value placed on risk mitigation by leaders is demonstrated by keen interest in the organization’s safety environment through executive rounding and hiring of talented directors/managers of risk and safety programs who continuously promote safe actions throughout the enterprise.
Variation, expectations, consent, litigation and GIRFT…
Published in British Journal of Neurosurgery, 2022
Three distinct studies identified the following three primary motivations for filing medical malpractice claims: 1) holding the physician or health system accountable, 2) seeking an explanation for the adverse outcome, and 3) financial reward.2 While poor outcomes and financial incentives are certainly motivations in litigation, the physician-patient relationship is the primary motivation. A good relationship can protect against claims while a poor relationship is a significant risk factor, independent of outcomes. An overwhelming majority of patients cite trust as the most important predictor for patient satisfaction, even greater than perceived clinical competence of the practitioner. A successful physician-patient relationship lies in communication. Distrust within the relationship is associated with poor outcomes. By ensuring strong communication, the patient and the neurosurgeon may confidently participate as partners in informed decision-making, perhaps even learning together in the process. With the neurosurgeon as a partner in the decision-making process, the patient will not view their provider as an adversary in the event of a poor outcome, thus hopefully reducing the risk of litigation.
Exploring the first pressure injury and characteristics of subsequent pressure injury accrual following spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2021
Alexandra E. Harper, Lauren Terhorst, David Brienza, Natalie E. Leland
The onset of a pressure injury (previously referred to as pressure ulcer by the National Pressure Ulcer Advisory Panel [NPUAP]) is a common complication following a new spinal cord injury (SCI), with 33%–49% of people reporting the development of at least one during acute care and inpatient rehabilitation.1–3 Moreover, this adverse outcome is associated with decreased quality of life and independence as well as increased caregiver burden, length of stay, and healthcare utilization.4,5 Multiple factors are reported to be associated with initial pressure injury development following SCI (e.g. SCI severity,1,6 requiring assistance for transfers7), and this information is incorporated into clinical practice guidelines to direct prevention efforts.
Predictability of adverse outcomes in hypertensive disorders of pregnancy: a multicenter prospective cohort study
Published in Hypertension in Pregnancy, 2021
Daniela N. Vasquez, Andrea V. Das Neves, Vanina M. Aphalo, Laura Vidal, Miriam Moseinco, Jorge Lapadula, Analía Santa-Maria, Graciela Zakalik, Raúl A. Gomez, Mónica Capalbo, Claudia Fernandez, Enrique Agüero-Villareal, Santiago Vommaro, Marcelo Moretti, Silvana B. Soli, Florencia Ballestero, Juan P. Sottile, Viviana Chapier, Carlos Lovesio, José Santos, Fernando Bertoletti, Fernando A. Mos, Alejandro Risso-Vazquez, Mercedes Esteban-Chacon, Santiago Illutovich, Sebastián Chapela, Cecilia I. Loudet, José L. Scapellato, Alfredo D. Intile, Elisa Estenssoro
While the other risk factors for composite adverse outcome are more straightforward, understanding why receiving health care in the public sector is included is imperative. In Argentina, the level of intervention in both the public and private sectors are exactly the same. However, patients who arrive to third level public hospitals are often transferred from other first- or second-level health-care facilities after having either waited too long due to lack of disease recognition resulting from low level of education, or the inability to advocate for themselves effectively and not being taken seriously. In addition, patients using the public healthcare system often have poor prenatal care for the same reasons (3). Patients admitted with advanced disease are prone to more complications, many of which could be prevented by empowering women and improving education and healthcare access, among other actions (3,26).