Using medicolegal data to support safe medical care: A contributing factor coding framework

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.

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“…To reduce the risk of misclassification, coders conduct weekly quality-assurance reviews of case coding. 16…”

Section: Setting Design and Data Sourcesmentioning

confidence: 99%

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

Yang

Zhang

Hines

et al. 2018

cmajo

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“…13 Analysts use an in-house CMPA coding framework to categorize patient safety incidents and the contributing factors (categorized as provider-, team-, or system-related) based on peer expert opinions (see Appendix A for glossary of medicolegal terms). 14 In this context, we defined peer experts as physicians retained by the parties in a legal action to interpret and provide their opinion on clinical, scientific, or technical issues surrounding the care provided. They are typically of similar training and experience as the physicians whose care they are reviewing.…”

Section: Data Repository and Medicolegal Codingmentioning

confidence: 99%

Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association

Crosby

Duggan

Finestone

et al. 2020

Can J Anesth/J Can Anesth

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Purpose We analyzed closed civil legal cases in 2007-2016 from the Canadian Medical Protective Association (CMPA) involving specialist anesthesiologists where airway management was the central concern. Methods We included all airway-related civil legal cases involving specialist anesthesiologists that closed from 2007 to 2016. The following variables were abstracted by CMPA medical analysts: clinical context, peer expert opinions of contributing factors, and patient and legal outcomes. Results We found 46 of the 406 (11%) closed cases involving anesthesiologists to be airway-related. Twenty-six cases (57%) involved elective surgery and 31 patients (67%) were categorized as American Society of Anesthesiologists physical status III. Twenty-five cases (54%) occurred outside the operating room (e.g., postanesthesia care unit, intensive care unit, or other satellite locations). In 19 (42%) cases, there was at least one predictor of a difficult airway. Peer experts identified judgement failures in 30 cases (65%), most commonly inadequate airway evaluation. In 30 cases (65%), the patient died or had a permanent brain injury. The medicolegal outcome favoured the patient in 27 (59%) cases, with a median [interquartile range] payment of 422,845 [257,637-935,673] CAD. Conclusions Severe patient harm is common when airway management is the focus of a CMPA medicolegal complaint involving anesthesiologists. Patients were otherwise typically low risk cases presenting for elective surgery. Failure to assess or to change management based on the airway exam or encountered difficulty were the most common errors. Our findings support the continued need for adoption, adherence, and practice of guidelines for anticipated and unanticipated difficult airway management for every patient encounter.

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“…The doctor who prepares the medicolegal report is like an expert witness which is helping the court of law in the given criminal case so the medicolegal report has to be made timely, meticulously and in an unbiased manner. 4,5 Medicolegal cases may present at varying time intervals after the trauma is inflicted. Sometimes the patient arrives days or weeks after the given history of trauma, in which case a careful history and thorough examination is necessary to ascertain the actual and realistic estimation of injuries.…”

Section: Introductionmentioning

confidence: 99%

Etiology of Ophthalmic Medicolegal Cases Presenting to Tertiary Care Hospital.

Amjad

Shaheer

Saleem

2019

TPMJ

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Objectives: To study the etiology and visual acuity profile of ophthalmic medicolegal cases presenting to a tertiary care hospital. Study Design: Retrospective study. Setting: Lahore General Hospital, Lahore. Period: 1-3-2017 to 30-10-2018. Methodology: This retrospective study was conducted after taking ethical approval from the institutional review board. Record of medicolegal cases presenting during the study period were studied and assessed. In this study, etiology of trauma inflicted to eye and visual acuity at presentation were analyzed in addition to the age, gender and eye distribution. Age and visual acuity were categorized into subsets for assessment. Results: The authors reviewed the data of 40 ophthalmic medicolegal cases presenting to the department. The medicolegal cases were common in patients aging between 21-30 years (32.5%) which predominantly involved males (65%). Right eye was involved in 40% of patients and 35% of patients had normal (6/6) visual acuity. Most common trauma inflicted to eye was by fist or blow from hand in 75% of cases. Conclusion: Trauma to eye in medicolegal cases is common and is frequently inflicted by fist or hand.

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Using medicolegal data to support safe medical care: A contributing factor coding framework

Abstract: We believe that reframing medicolegal case coding systems to better identify the influence of team, organizational, and system factors will increase the utility of this analysis in patient safety research, and health care quality improvement.

Cited by 23 publications

References 14 publications

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

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

Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association

Etiology of Ophthalmic Medicolegal Cases Presenting to Tertiary Care Hospital.

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