Risk Management-Obstetrics and Gynecology Perspective.

The Obstetrics and Gynecology physician's likelihood to experience medical malpractice claims are higher than in other medical specialties. We will review the basic principles of health care risk management, the role of the risk manager, and the importance of health care risk management in risk mitigation for obstetrics and gynecology physicians. Attention is focused on medical record documentation, disclosure of adverse events, second victim programs, grievance management techniques, alternative dispute resolution concepts, regulatory inquiries including state licensure investigations, product failures, and electronic media strategies. Concluding, health care risk management may be used as a claim avoidance tool and provider protective vehicle for physicians.

Gender Bias in Risk Management Reports Involving Physicians in Training - A Retrospective Qualitative Study.

OBJECTIVE: Gender bias, which contributes to burnout and attrition of female medical trainees, may manifest as disparate workplace evaluations. Here, we explore gender-based differences in perceived competence and professionalism as described in an institutional electronic risk management reporting system. DESIGN: In this retrospective qualitative study, recurring themes were identified from anonymous entries reported to an electronic institutional risk management database from July 2014 to July 2015, and from July 2019 to July 2020 using inductive methods. This electronic system is often used by hospital staff to document complaints against physicians under the pretext of poor patient care, regardless of whether an adverse event occurred. Two individuals independently coded entries. Themes were determined from event indicator codes (EIC) using Delphi methodology and compared between gender and specialty using bivariate statistics. SETTING: A multi-center integrated healthcare delivery system. PARTICIPANTS: Risk management entries pertaining to physician trainees by hospital staff as written submissions to the institution's electronic risk management reporting system. Main outcomes included themes defined as: (1) lack of professionalism (i.e., delay in response, attitude, lack of communication), (2) perceived medical error, (3) breach of institutional protocol. RESULTS: Of the 207 entries included for analysis, 52 entries identified men (25%) and 31 entries identified women (15%). The gender was not available in 124 entries and, therefore, categorized as ambiguous. The most common complaint about men involved a physician-related EIC (n = 12, 23%, EIC TX39) and the most common complaint about women involved a communication-related EIC (n = 7, 23%, EIC TX55). Eighty-eight (43%) entries involved medical trainees; 82 (40%) involved surgical trainees. Women were more often identified by their name only (n = 8, 26% vs. n = 3, 6%; p < 0.001). This finding was consistent in both medical (n = 0, 0% vs. n = 5, 31%; p < 0.001) and surgical (n = 2, 7% vs. n = 3, 25%; p = 0.006) specialties. In entries involving women, a lack of professionalism was most frequently cited (n = 29, 94%). Entries identifying medical errors more frequently involved men (n = 25, 48% vs. n = 7, 23%; p = 0.02). CONCLUSIONS: Gender-based differences exist in how hospital staff interpret trainees' actions and attitudes. These differences have consequences for training paradigms, perceptions of clinical competence, physician burnout, and ultimately, patient outcomes.

Do Written Disclosures of Serious Events Increase Risk of Malpractice Claims? One Health Care System's Experience.

OBJECTIVE: This study aimed to determine whether Pennsylvania ACT 13 of 2002 (Mcare) requiring the written and verbal disclosure of "serious events" was accompanied by increased malpractice claims or compensation costs in a large U.S. health system. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of malpractice claims. The secondary outcome was the amount paid for compensation of malpractice claims. The analyses tested the relationship between the rate of serious event disclosures and the outcome variables, adjusted for the year of the event, category of claim, and the degree of "harm" related to the event. RESULTS: There were 15,028 serious event disclosures and 1302 total malpractice claims among 1,587,842 patients admitted to UPMC hospitals from May 17, 2002, to June 30, 2011. As the number of serious event disclosures increased, the number of malpractice claims per 1000 admissions remained between 0.62 and 1.03. Based on a matched analysis of claims that were disclosed and those that were not (195 pairs), disclosure status was significantly associated with increased claim payout (disclosures had 2.71 times the payout; 95% confidence interval, 1.56-4.72). Claims with higher harm levels H and I were independently associated with higher payouts than claims with lower harm levels A to D (11.15 times the payout; 95% confidence interval, 2.30-54.07). CONCLUSIONS AND RELEVANCE: Implementation of a mandated serious event disclosure law in Pennsylvania was not associated with an overall increase in malpractice claims filed. Among events of similar degree of harm, disclosed events had higher compensation paid compared with those that had not been disclosed.

Prevalence of BRCA mutations in an unselected population of triple-negative breast cancer.

BACKGROUND: This study assessed BRCA1 and BRCA2 mutation prevalence in an unselected cohort of patients with triple-negative breast cancer (BC). METHODS: One hundred ninety-nine patients were enrolled. Triple negativity was defined as <1% estrogen and progesterone staining by immunohistochemistry and HER-2/neu not overexpressed by fluorescence in situ hybridization. Having given consent, patients had BRCA1 and BRCA2 full sequencing and large rearrangement analysis. Mutation prevalence was assessed among the triple-negative BC patients and the subset of patients without a family history of breast/ovarian cancer. Independent pathological review was completed on 50 patients. RESULTS: Twenty-one deleterious BRCA mutations were identified--13 in BRCA1 and 8 in BRCA2 (prevalence, 10.6%). In 153 patients (76.9%) without significant family history (first-degree or second-degree relatives with BC aged <50 years or ovarian cancer at any age), 8 (5.2%) mutations were found. By using prior National Comprehensive Cancer Network (NCCN) guidelines recommending testing for triple-negative BC patients aged <45 years, 4 of 21 mutations (19%) would have been missed. Two of 21 mutations (10%) would have been missed using updated NCCN guidelines recommending testing for triple-negative BC patients aged <60 years. CONCLUSIONS: The observed mutation rate was significantly higher (P = .0005) than expected based on previously established prevalence tables among patients unselected for pathology. BRCA1 mutation prevalence was lower, and BRCA2 mutation prevalence was higher, than previously described. Additional mutation carriers would have met new NCCN testing guidelines, underscoring the value of the updated criteria. Study data suggest that by increasing the age limit to 65 years, all carriers would have been identified.

The nurse's role in the causation of compensable injury.

Mistakes can be life-threatening and result in malpractice claims. There are few studies that discuss malpractice claims and nursing. The purpose was to identify possible relationships between the actions, behaviors, or characteristics of RNs and the injury suffered by a patient involved in a compensable event. Claims were analyzed retrospectively. Using the Fischer exact test, nurse inaction yielded a higher patient outcome severity score. No single nurse behavior or characteristic was significantly related to the patient outcome severity score. Findings support the belief that system problems may be a contributing factor.

Actions, behaviors, and characteristics of RNs involved in compensable injury.

Malpractice claims analysis offers valuable insight into nursing practice. A review of 16 malpractice claims involving 19 RNs identified their characteristics, actions, and behaviors that contributed to monetary compensation. Most events involved failure to perform a timely assessment and intervention. Relationships were found among nurses' characteristics and the severity of patient injury. Malpractice claims analysis affords nursing leaders the opportunity to involve RNs in correcting deficiencies that contribute to practice errors.

Factors that influence adherence to HIV medications: perceptions of women and health care providers.

The purpose of this pilot study was to explore factors that influence adherence to antiretroviral therapy (ART) in women with human immunodeficiency virus (HIV) disease. Antiretroviral medications that reduce viral count and prolong the time between a diagnosis of HIV disease and acquired immunodeficiency syndrome (AIDS) are expensive, numerous, and have multiple side effects. Common reasons for not adhering to the medication regimen include ART side effects and a dosage schedule that disrupts daily activities. Failure to take or errors in taking ART can result in an exacerbation of symptoms and disease progression or the development of drug-resistant strains of HIV. Women and providers in separate focus groups identified factors that facilitated and hindered adherence to ART. Knowledge of factors that influence adherence to ART will facilitate the development of interventions. Patient-provider relationships and side effects of weight gain are discussed as factors that influence adherence to ART.