This article summarizes available information on the efficiency and effectiveness of generic occurrence screening when used in quality assessment. Generic screening is relatively inefficient because of its multitiered review system and high rates of errors and false positives. Overall sensitivity may approach 70% to 80%, but specificity is estimated to range from about 22% to 73%. Effectiveness of generic screening in identifying problems in quality is limited by variability in peer review. Other limitations of generic screens include their lack of inherent relationship to the quality of patient care and their inability to provide direct performance measures for use in the periodic reappraisal of clinical privileges of medical staff members. We propose the monitoring of specific adverse surgical and medical clinical outcomes and related risk factors to increase efficiency in quality assessment and provide a more adequate database for the continual improvement of patient care and clinical performance.
INTRODUCTION This article provides evidence that prompt incident reporting by medical professionals can serve a useful "early warning" function to identify future medical malpractice claims. Unlike traditional incident reports that focus on largely minor injuries caused by non-physician employees of medical facilities, the reporting system described in this article was designed to capture significant medical injuries before claimants' lawyers do so. Physicians helped to design this new system, which encourages prompt reporting-especially by telephone or face to face with risk managers, not merely through the conventional, standard written forms. This article is part of a larger study of early warning, which explores how early warning is used and how it can be improved.I The main goal of the study was to confirm or deny the operative philosophy that early warning based on incident reports or occurrence reports could improve claims processing and outcomes. The data discussed here show that malpractice claims established on the basis of early warning incident reports not only involve the full range of injury severity, but also identify claims warranting substantial indemnity payments. These claims are generally brought to the
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