Fetal asphyxia is the most common reason for compensation, resulting in large financial expenses to society. Human error contributes to inadequate health care in 92% of obstetric compensation claims, although underlying system errors may also be present.
Objective. To analyze compensation claims with neurological sequela or death following alleged birth asphyxia. Design. A cohort study. Setting. A nationwide study in Norway. Sample. All claims made to The Norwegian System of Compensation to Patients (NPE) concerning sequela related to alleged birth asphyxia, between 1994 and 2008. A total of 315 claims of which 161 were awarded compensation. Methods. Examination of hospital records, experts' assessments and the decisions made by the NPE, the appeal body and courts of law. Main outcome measures. Characteristics of deliveries resulting in intrapartum asphyxia and causes of substandard care categorized in eight groups. Results. In the 161 compensated cases, 107 children survived (96 with neurological sequela), and 54 children died. Human error was a frequent reason of substandard care, seen as inadequate fetal monitoring (50%), lack of clinical knowledge and skills (14%), noncompliance with clinical guidelines (11%), failure in referral for senior medical help (10%) and error in drug administration (4%). System errors were registered in only 3%, seen as poor organization of the department, lack of guidelines and time conflicts. The health personnel held responsible for substandard care was an obstetrician in 49% and a midwife in 46%. Conclusions. Substandard care is common in birth asphyxia, and human error is the cause in most cases. Inadequate fetal monitoring and lack of clinical knowledge and skills are the most frequent reasons for compensation after birth asphyxia.Abbreviations: NPE, The Norwegian System of Compensation to Patients.
During a period of 1 month, 3 episodes of probable or actual venous air embolism occurred during hysteroscopic surgery. All patients developed the same symptoms of ventilatory and hemodynamic decompensation, beginning with a reduction in end-tidal carbon dioxide, arterial desaturation, and cyanosis on the upper trunk, and rapidly progressed to hypotension and 2 cardiac arrests. While entrainment of some air is common during hysteroscopy, life-threatening embolism is a rare but serious complication for which an anesthetist needs to be vigilant and prepared. If even a small drop in end-tidal carbon dioxide occurs, venous air embolism should be suspected and the operation should be discontinued.
BACKGROUND: Most patients with endometrial cancer with localized disease are effectively treated and survive for a long time. The primary treatment is hysterectomy, to which surgical staging procedures may be added to assess the need for adjuvant therapy. Longitudinal data on patient-reported outcomes comparing different levels of primary treatment are lacking, especially when adjuvant radiotherapy is omitted. OBJECTIVE: We assessed the impact of lymphadenectomy and adjuvant chemotherapy on patient-reported symptoms, function, and quality of life. We hypothesized that these treatment modalities would substantially affect patient-reported outcomes at follow-up. STUDY DESIGN: We prospectively included patients with endometrial cancer enrolled in the ongoing MoMaTEC2 study (ClinicalTrials.gov Identifier: NCT02543710). Patients were asked to complete the patientreported outcome questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EN24 preoperatively and at 1 and 2 years of follow-up. Functional domains and symptoms were analyzed for the whole cohort and by treatment received. To assess the effect of the individual treatment modifications, we used mixed regression models. RESULTS: Baseline data were available for 448 patients. Of these patients, 339 and 219 had reached 1-year follow-up and 2-year followup, respectively. Treatment included hysterectomy (plus bilateral salpingo-oophorectomy) alone (n¼177), hysterectomy and lymph node staging without adjuvant therapy (n¼133), or adjuvant chemotherapy irrespective of staging procedure (n¼138). Overall, patients reported improved global health status and quality of life (þ9 units; P<.001), increased emotional and social functioning, and increased sexual interest and activity (P<.001 for all) from baseline to year 1, and these outcomes remained stable at year 2. Means of functional scales and quality of life were similar to age-and sex-weighted reference cohorts. Mean tingling and numbness and lymphedema increased after treatment. The group who received adjuvant chemotherapy had a larger mean reduction in physical functioning (À6 vs þ2; P¼.002) at year 1, more neuropathy (þ30 vs þ5; P<.001; year 1) at years 1 and 2, and more lymphedema at year 1 (þ11 vs þ2; P¼.007) than the group treated with hysterectomy and salpingo-oophorectomy only. In patients not receiving adjuvant chemotherapy, patient-reported outcomes were similar regardless of lymph node staging procedures. Adjuvant chemotherapy independently increased fatigue, lymphedema, and neuropathy in mixed regression models. CONCLUSION: Patients with endometrial cancer receiving adjuvant chemotherapy reported significantly reduced functioning and more symptoms up to 2 years after treatment. For patients treated by surgery alone, surgical staging did not seem to affect the quality of life or symptoms to a measurable degree at follow-up. Therefore, subjecting patients to lymph nod...
(BJOG. 2015;122(7):948–953) In Norway, patients who believe they have been injured by the health care system may apply for compensation to the Norwegian System of Compensation to Patients (NPE), a no-blame system which can dispense compensation without anyone being proven guilty of negligence.
We found increased neonatal morbidity after vaginal deliveries of breech presentations, but the increase was about the same as that forming the basis for the national guidelines. We therefore choose to continue our practice with recommended vaginal delivery in breech presentation after careful selection.
Objective The aim of this study was to investigate the consistency of experts' evaluation of different types of obstetric claims for compensation.Design Inter-rater reliability study of obstetric claims for compensation.Setting Medical experts' evaluation in The Norwegian System of Compensation to Patients, a no-blame system.Sample The 15 most frequently used medical experts were asked to evaluate 12 obstetric claims applied for compensation.Methods Inter-rater agreement was assessed by absolute agreement, Fleiss' kappa statistic and Gwet's AC1.Main outcome measures Consistency in the evaluation of negligence (carelessness without intention to harm) and causality (relation between care and injury) between negligence and patient injury.Results The experts demonstrated moderate consistency in their evaluation of negligence (Fleiss' kappa = 0.53/AC1 = 0.54) and causality (Fleiss' kappa = 0.41/AC1 = 0.54). There was a higher level of agreement in clinical scenarios with well-documented diagnostic criteria and guidelines, including shoulder dystocia and asphyxia with low Apgar score and metabolic acidosis. ConclusionWe found a moderate level of agreement in experts' evaluation of negligence and causality between the injury and provided health care, the two most important questions to be answered in obstetric claims for compensation.Keywords Agreement, consistency, guidelines, inter-rater reliability, medical experts, negligence, obstetrics.Please cite this paper as: Andreasen S, Backe B, Lydersen S, Øvrebø K, Øian P. The consistency of experts' evaluation of obstetric claims for compensation. BJOG 2015;122:948-953.
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