Adverse events in anesthesia: Analysis of claims against anesthetists affiliated to an insurance fund in Colombia. Cross-sectional study

  • Juan Carlos Bocanegra Rivera Wellbeing, Safety and Occupational Health Committee, Colombian Society of Anesthesia and Resuscitation (S.C.A.R.E.). Bogotá, Colombia.
  • Luz María Gómez Buitrago Scientific Deputy Office, Colombian Society of Anesthesia and Resuscitation (S.C.A.R.E.). Bogotá, Colombia. https://orcid.org/0000-0002-5156-3829
  • Nubia Fernanda Sánchez Bello Quality Research, Safety and Health Education Group, Scientific Research and Publications Area, Colombian Society of Anesthesia and Resuscitation (S.C.A.R.E.). Bogotá, Colombia. https://orcid.org/0000-0002-4906-2144
  • Alexandra Chaves Vega Wellbeing, Safety and Occupational Health Committee, Colombian Society of Anesthesia and Resuscitation (S.C.A.R.E.). Bogotá, Colombia.
Keywords: Administrative claims, healthcare, Anesthesiology, Operating rooms, Patient safety, Liability, legal, Adverse events

Abstract

Introduction: Prevention, identification, analysis and reduction of adverse events (AEs) are all activities designed to increase safety of care in the clinical setting. Closed claims reviews are a strategy that allows to identify patient safety issues. This study analyzes adverse events resulting in malpractice lawsuits against anesthesiologist affiliated to an insurance fund in Colombia between 2013-2019.

Objective: To analyze adverse events in closed medicolegal lawsuits against anesthesiologist affiliated to an insurance fund between 2013-2019.

Methods: Cross-sectional observational study. Convenience sampling was used, including all closed claims in which anesthesiologist affiliated to an insurance fund in Colombia were sued during the observation period. Variables associated with the occurrence of AEs were analyzed.

Results: Overall, 71 claims were analyzed, of which 33.5% were due to anesthesia-related AEs. Adverse events were found more frequently among ASA I-II  patients (78.9%), and in surgical procedures (95.8%). The highest number of adverse events occurred in plastic surgery (29.6%); the event with the highest proportion was patient death (43.7%). Flaws in clinical records and failure to comply with the standards were found in a substantial number of cases.

Conclusions: When compared with a previously published study in the same population, an increase in ethical, disciplinary and administrative claims was found, driven by events not directly related to anesthesia. Most of the anesthesia-related events occurred in the operating theater during surgical procedures in patients and procedures categorized as low risk, and most of them were preventable.

References

Fleisher LA. Quality anesthesia: Medicine measures, patients decide. Anesthesiology. 2018;129(6):1063-9. doi: http://doi.org/10.1097/ALN.0000000000002455.

Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. Washington (DC): National Academies Press (US); 2001.

Aranaz-Andrés JM, Aibar-Remón C, Limón-Ramírez R, Amarilla A, Restrepo FR, Urroz O, et al. IBEAS design: adverse events prevalence in Latin American hospitals. Rev Cal Asist. 2011;26(3):194-200. doi: https://doi.org/10.1016/j.cali.2010.12.001

Cooper JB, Longnecker D. Seguridad y calidad: Los principios que guían la atención centrada en el paciente. En: Anestesiología de Longnecker. McGraw-Hill; 2008. pp. 20-39.

Thomas EJ, Petersen LA. Measuring errors and adverse events in health care. J Gen Intern Med. 2003;18(1):61-7. doi: http://doi.org/10.1046/j.1525-1497.2003.20147.x.

Cheney FW. The American Society of Anesthesiologists Closed Claims Project: What have we learned, how has it affected practice, and how will it affect practice in the future? Anesthesiology. 1999;91:552-6. https://doi.org/10.1097/00000542-199908000-00030

Kent CD, Metzner JI, Domino KB. Anesthesia hazards: lessons from the anesthesia closed claims project. Int Anesthesiol Clin. 2020;58(1):7-12. doi: http://doi.org/10.1097/AIA.0000000000000256.

Taylor-Adams S, Vincent C. Systems analysis of clinical incidents. The London Protocol. Journal of Patient Safety and Risk Management. 2004;10:211-20. doi: https://doi.org/10.1258/1356262042368255

Stones J, Yates D. Clinical risk assessment tools in anaesthesia. BJA Education. 2019;19(2):47-53. doi: http://doi.org/10.1016/j.bjae.2018.09.009

Story DA, Leslie K, Myles PS, Fink M, Poustie SJ, Forbes A, Yap S, Beavis V, Kerridge R. Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study. Anaesthesia. 2010;65(10):1022-30. doi: http://doi.org/10.1111/j.1365-2044.2010.06478.x.

Bocanegra JC, Arias JH. Characterization and analysis of adverse events in closed liability cases involving anaesthetists who received legal support from the Colombian Society of Anaesthesia and Resuscitation (S.C.A.R.E.), Colombia, 1993-2012. Colombian Journal of Anesthesiology. 2016;44(3):203-10. doi: https://doi.org/10.1016/j.rca.2016.04.008

Metzner J, Posner KL, Lam MS, Domino KB. Closed claims' analysis. Best Pract Res Clin Anaesthesiol. 2011;25(2):263-76. doi: http://doi.org/10.1016/j.bpa.2011.02.007.

Parera A. Responsabilidad profesional médica en anestesia, reanimación y terapia del dolor. Análisis del período 2000-2013 [tesis doctoral]. Universidad Autónoma de Barcelona [internet]. 2016 [Cited 2021Jan 12]. Available at: https://ddd.uab.cat/pub/tesis/2016/hdl_10803_400753/apr1de1.pdf

Bayter JE. Catástrofes en cirugía plástica. Bogotá, Colombia: Sociedad Colombiana de Anestesiología y Reanimación; 2015.

Ortega S, Trejos E, Gaviria J, Bayter J, Galán R. Decreased risk in plastic surgery. Recommendations. Part I: generalities and facial cosmetic surgery. Revista Colombiana de Cirugía Plástica y Reconstructiva. 2018;24(1):51-63.

de Santana Lemos C, de Brito Poveda V. Adverse events in anesthesia: An integrative review. J Perianesth Nurs. 2019;34(5):978-98. doi: http://doi.org/10.1016/j.jopan.2019.02.005

MacRae MG. Closed claims studies in anesthesia: a literature review and implications for practice. AANA J. 2007;75(4):267-75.

Baxter AD, Boet S, Skidmore G. The aging anesthesiologist: a narrative review and suggested strategies. Can J Anaesth. 2014;61(9):865-75. doi: http://doi.org/10.1007/s12630-014-0194-x.

Vincent C, Taylor-Adams S, Chapman EJ, Hewett D, Prior S, Strange P, Tizzard A. How to investigate and analyse clinical incidents: clinical risk unit and association of litigation and risk management protocol. BMJ. 2000;320(7237):777-81. doi: http://doi.org/10.1136/bmj.320.7237.777.

Cooper JB, Newbower RS, Long CD, McPeek B. Preventable anesthesia mishaps: a study of human factors. 1978. Qual Saf Health Care. 2002;11(3):277-82. doi: http://doi.org/10.1136/qhc.11.3.277.

Normas Mínimas de Seguridad en Anestesiología. SCARE [internet]. 2015 [cited 2021 Feb 28]. Available at: https://scare.org.co/wp-content/uploads/Normas-minimas-vd.pdf

Flin R, Fioratou E, Frerk C, Trotter C, Cook TM. Human factors in the development of complications of airway management: preliminar e evaluation of an interview tool. Anaesthesia. 2013;68:817-825. doi: http://doi.org/10.1111/anae.12253.

Wright SM. Patient safety in anesthesia: learning from the culture of high-reliability organizations. Crit Care Nurs Clin North Am. 2015;27(1):1-16. doi: http://doi.org/10.1016/j.cnc.2014.10.010.

Domen R, Connelly CD, Spence D. Call-shift fatigue and use of countermeasures and avoidance strategies by certified registered nurse anesthetists: a national survey. AANA J. 2015;83(2):123-31.

Petty WC, Kremer M, Biddle C. A synthesis of the Australian Patient Safety Foundation Anesthesia Incident Monitoring Study, the American Society of Anesthesiologists Closed Claims Project, and the American Association of Nurse Anesthetists Closed Claims Study. AANA J. 2002;70(3):193-202.

Staender S, Schaer H, Clergue F, Gerber H, Pasch T, Skarvan K, Meister B. A Swiss anaesthesiology closed claims analysis: report of events in the years 1987-2008. Eur J Anaesthesiol. 2011;28(2):85-91. doi: http://doi.org/10.1097/EJA.0b013e3283414fea.

Wilbanks BA, Geisz-Everson M, Boust RR. The role of documentation quality in anesthesia-related closed claims: A descriptive qualitative study. Comput Inform Nurs. 2016;34(9):406-12. doi: http://doi.org/10.1097/CIN.0000000000000270.

How to Cite
1.
Bocanegra Rivera JC, Gómez Buitrago LM, Sánchez Bello NF, Chaves Vega A. Adverse events in anesthesia: Analysis of claims against anesthetists affiliated to an insurance fund in Colombia. Cross-sectional study. Colomb. J. Anesthesiol. [Internet]. 2022Jun.22 [cited 2022Aug.14];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1043

Downloads

Download data is not yet available.
Published
2022-06-22
How to Cite
1.
Bocanegra Rivera JC, Gómez Buitrago LM, Sánchez Bello NF, Chaves Vega A. Adverse events in anesthesia: Analysis of claims against anesthetists affiliated to an insurance fund in Colombia. Cross-sectional study. Colomb. J. Anesthesiol. [Internet]. 2022Jun.22 [cited 2022Aug.14];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1043
Section
Original
Crossref Cited-by logo

More on this topic