Improved hospital safety performance and reduced medicolegal risk: an ecological study using 2 Canadian databases

Abstract

Background: Few empirical studies have validated the relation between medicolegal risk and hospital patient safety performance. We sought to determine whether there was a relation between in-hospital patient safety events and medicolegal cases involving Canadian physicians. Methods: In this ecological study, we used Poisson regression to compare data from the Canadian Institute for Health Information's Discharge Abstract Database and the database of the Canadian Medical Protective Association (CMPA) of medicolegal cases over 10 years (2005/06 to 2014/15). We identified incidents and cases based on 15 Agency for Healthcare Research and Quality patient safety indicators within the Canadian Institute for Health Information and CMPA data sets. We performed subgroup analyses for obstetrical and surgical cases. Results: We found a statistically significant positive association between volume changes in patient safety indicator events (n = 339 741) and medicolegal cases (n = 15 180) (parameter estimate 1.15, 95% confidence interval [CI] 0.4 to 1.9). This association suggests that, on average, a 10% decrease in events would correspond to a decrease of 11% in medicolegal cases. The degree of positive association varied by practice type, with obstetrics (97 982 patient safety indicator events, 865 cases) showing a 25% decrease in medicolegal cases for every 10% decrease in events (parameter estimate 2.9, 95% CI 0.5 to 5.3) and surgery (168 886 patient safety indicator events, 4568 cases) showing a decrease of 9% for every 10% decrease in events (parameter estimate 0.9, 95% CI 0.2 to 1.7). Interpretation: The statistically significant positive association between patient safety indicator events and medicolegal cases quantifies a relation between patient safety and physician medicolegal risk in Canadian hospitals. This suggests new, practical uses for both medicolegal and patient safety indicator data in system-level quality-improvement efforts.

Evaluation of validity and reliability of video analysis and live observations to assess trauma team performance

“…[24] Interestingly, only 2.8% of trauma centers had first-hand experience with a video analysisrelated medical-legal problem. Moreso, video review may even reduce medicolegal cases, as Yang et al [29] found a significant relation between patient safety and the risk of medicolegal involvement of physician in Canadian hospitals. In other words, video review may enhance patient safety, which may result in less medicolegal issues of physicians.…”

“…Finally, there are some recently described advanced methods available that could significantly ano[nymize] patients and personnel in the trauma room. In the study by Silas et al (29) videos of operating rooms during surgery were processed into point clouds. Recognition of staff by their colleagues was rated using a Likert scale, where the score of 1 was anonymous, (unable to identify) and a score of 10 was not anonymous, (easy to identify) The mean scores for unaltered and point cloud videos were 7.05 and 1.41, respectively (p < 0.001).…”

Clinical negligence costs: taking action to safeguard NHS sustainability

“…The best way to control costs, however, is to improve safety so that both patient harm and subsequent litigation are reduced. Improving safety in health systems overall is likely to reduce the level of avoidable harm and thus decrease litigation111213: the recently published NHS patient safety strategy suggested potential to reduce claims provision by around £750m a year by 2025, for example. The Public Accounts Committee’s 2017 report accordingly recommended that urgent and coordinated action be taken to reduce patient harm, especially in maternity care 4.…”

Ethical, legal and administrative implications of the use of video and audio recording in an emergency department in Ontario, Canada

“…Canadian data support the merits of transition, with evidence demonstrating a reduction of patient safety incidents is associated with reduced physician medicolegal risk. 31 From a physician medicolegal risk management perspective, engagement in programme QI initiatives seems to be a powerful tool against medicolegal liability. Particular to VAR programmes, physicians may perceive increased vulnerability to litigation and patient complaints.…”