How risky is caring for emergency patients at risk of malpractice litigation: a population based epidemiological study of Taiwan's experiences

<p>Abstract</p> <p>Background</p> <p>Emergency medicine has generally been considered a high risk specialty. The purpose of this study is to assess the risk of being sued in the district courts for caring emergency room (ER) patients from the perspective of epidemiology.</p> <p>Methods</p> <p>This research was designed to be a retrospective population based cohort study. We intended to find out the incidence of litigations arising from ER patients and that of birth inpatients in Taiwan, and computed their relative risks. The inclusion criterion was set to be incidents transpired in the time period of 1998 to 2002. The study materials included the reimbursement claim dataset of the National Health Insurance from 1998 to 2002, and the district court decision database of the Judicial Yuan from 1999 to 2006.</p> <p>Results</p> <p>The average annual incidence rate of becoming a plaintiff for ER patients is 0.86 per million, and for birth patients is 33.5 per million. There is a statistically significant difference between birth patients and ER patients. The relative risk comparing ER patients against birth inpatients is 0.03.</p> <p>Conclusion</p> <p>The findings of this population based study indicate that the patient population emergency physicians are facing in Taiwan have relatively lower risks of developing litigation in comparison with the patients that come to give birth. Due to the large volume of ER patients, malpractice still pose a major threat in the emergency department, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations.</p

Towards integration of general practitioner posts and accident and emergency departments: a case study of two integrated emergency posts in the Netherlands

<p>Abstract</p> <p>Background</p> <p>Accident and emergency (A&E) departments and general practitioner (GP) posts are often used inappropriately, leading to overcrowding. In the Netherlands, increasingly more integrated emergency posts (IEPs) are being created, integrating the care provided by GP posts and A&E departments, in order to improve the provision of the emergency care.</p> <p>Methods</p> <p>This explorative study compares the efficiency and patient and employee satisfaction in IEPs with those in two GP posts and two A&E departments. To this end, information was retrieved from hospital and GP patient records for the first quarter of the year before and of the year after the creation of IEPs. Patients and employees were sent a questionnaire to measure their satisfaction. Lastly, groups of hospital doctors, GPs, GP assistants, and nurses were interviewed.</p> <p>Results</p> <p>After the creation of IEPs, there was a shift of more than fifteen percent from secondary care to primary care for emergency consultations and waiting/consultation times were shortened by more than ten percent. Compared with the control settings, patients were more satisfied about telephone contact with an IEP, but professionals working at the IEP were less satisfied with several aspects of their work.</p> <p>Conclusion</p> <p>IEPs could be a promising innovation to organize emergency care more efficiently; however, it might take time to convince professionals of the possible advantages. Studies involving more IEPs and longer follow-up times are needed to determine whether such integration should be stimulated.</p

Spoedeisende Geneeskunde. Patiëntkarakteristieken en behoefte aan een opleiding tot SEH-arts.

Contains fulltext : 53301.pdf (publisher's version ) (Closed access)RU Radboud Universiteit Nijmegen, 19 september 2007Promotor : Vugt, A.B. van Co-promotor : Simons, M.P.142 p

Morbidity and Mortality after Emergency and Urgent Colorectal Surgery for Malignant and Benign Disease

Abstract: Aim: The aim of this study was to determine short and long-term morbidity and mortality rates after emergency colorectal surgery for benign and malignant disease in a high volume tertiary referral hospital in order to define factors predictive for outcome. Material and Methods: Characteristics and outcome of 196 consecutive emergency and 292 consecutive elective colorectal procedures were studied. A total of 91/196 emergency procedures were performed for malignant disease. The procedures reviewed included both palliative and curative procedures performed on an unselected patient population. Results were analysed by Cox regression and Kaplan-Meier analysis. Results: The total 30-day mortality for emergency and elective surgery was 20% and 3 % respectively, 36-month mortality was 48% and 27%. The frequency of major or moderate complications after emergency procedures was 39%. The strongest predictors for 30 day mortality after emergency surgery were ASA score (Odds Ratio 2.5) and age (OR 1.5). Predictors for early postoperative complications were faecal contamination during surgery (OR 4.2) and ASA score (OR 2.0). The strongest predictor for 3 year mortality after emergency surgery was malignant disease (OR = 5.0). Other predictors for long-term outcome were procedures performed and degree of specialization of the surgeon. Conclusions: Short-term outcome is associated with patient and disease related factors, whereas long-term outcome is also correlated to the primary diseases, procedures performed and the degree of specialization of the surgeon. Decisions concerning the level of qualifications required for emergency procedures should be based upon patient and disease related factors as well as the procedure to be performed

Karakteristieken van patiënten op de shockroom van een afdeling Spoedeisende Hulp in het centrum van Amsterdam.

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A description of emergency department-related malpractice claims in The Netherlands: closed claims study 1993-2001.

BACKGROUND: The aim of this study was to assess the quality of care provided at emergency departments (ED) in the Netherlands by analysing medical liability insurance claims. METHODS: A retrospective study performed by reviewing records at MediRisk, presently the largest insurer for medical liability in the Netherlands. The following data were abstracted from the files available for analysis: medical discipline involved, physician involved (resident or consultant), nature and gravity of the complaint, and final claim disposition. RESULTS: Between 1993 and 2001 a total of 326 claims involving the ED were filed at MediRisk. Of these, 256 claims (79%) were closed and were available for analysis. Medical liability claims were filed primarily for alleged errors in diagnosis and treatment. The majority of claims involved minor surgical conditions: fractures, luxations (joint dislocations), wounds and tendon injuries (210/256, 82%). Residents were involved in 76% of the claims; resident supervision by a consultant was documented in only 15% of the medical records. Permanent patient disability resulting from improper ED treatment was alleged in 22% of the claims. Four per cent of the claims involved the death of a patient. Physicians accepted liability in 16% of the claims filed. Indemnity payments during the 8-year study period totalled Euros 504,000. CONCLUSION: The number of medical liability claims is low compared with the number of patients treated in ED in the Netherlands. Claims primarily concerned alleged mistakes in diagnosis and the treatment of minor trauma. Residents were involved in the majority of the claims. More resident supervision is needed, as are specific training programmes for emergency physicians