[Experienced quality assurance in the IVOM structural contract of the AOK‑BW : A practical example]

[Legal aspects of quality assurance : Example of operative intravitreal injection therapy]

BACKGROUND

In the legal evaluation of medical treatments it is important to know which legal and contractual regulations apply.

OBJECTIVE

This article discusses in which context treatment errors play a role and are identified as such.

MATERIAL AND METHODS

Relevant German legal framework conditions are discussed and examples with reference to intravitreal injection therapy are given.

RESULTS

The civil law treatment contract between physician and patient results in the medical obligations of a service contract. As a consequence, the physician is obliged to provide the patient with treatment according to the current generally accepted professional standard, including information obligations, the certainty of a diagnosis, the execution of treatment and aftercare. Before claims for compensation and damages for pain and suffering can be enforced, proof of a treatment error and the causal connection must be provided. In court, mostly expert opinions are used to assess what the professional standard is and whether the physician was sufficiently qualified, whether informed consent and documentation met the legal requirements and whether a (gross) treatment error must be assumed. The Patients' Rights Act emphasizes the importance of an open error culture by requiring a practitioner to inform patients of third party/own treatment errors on request or in order to avert health risks, if circumstances are discernible to the practitioner that justify the assumption of a treatment error.

CONCLUSION

Although ophthalmologists cannot guarantee healing or success but only the treatment, there are many medical obligations for intravitreal therapy. Increased standards of quality assurance can be implemented within the framework of selective contracts.

[Value and formats of quality assurance : Ophthalmology and intravitreal therapy between reality and wishful thinking]

BACKGROUND

In view of the large number of patients and error-prone activities, legal requirements for quality assurance (QA) are of great importance for modern ophthalmology.

OBJECTIVE

This article discusses the need and formats of QA using the example of intravitreal operative medication injection therapy (IVOM).

MATERIAL AND METHODS

The legal framework conditions are briefly referenced and improvement potentials of the status quo are discussed.

RESULTS

The first quality control instruments were implemented for IVOM therapy; however, important quality indicators (number of treatments per patient/year, loss of follow-up, course of function) are not yet evaluated nationwide in Germany and cannot therefore be taken into account for continuous improvement and QA reports. To date, not all ophthalmologists involved have been under review in the field of basic diagnostics and follow-up. Limiting QA to ophthalmic surgeons alone does not improve quality and many statutory health insurances actively prevent scientific investigations within selective contracts.

CONCLUSION

For the QA of imaging diagnostics, similar proficiency measures (random samples, round robin testing) are required in ophthalmology as in radiological disciplines. The communication of transparent quality indicators can reduce the risk in the medium term. The quality of treatment and results must not be left to chance, cost pressure or convenience. The manufacturers of software and diagnostic equipment should be oriented towards radiology, where the exchange of voxel-oriented image formats is now less and less hindered by proprietary formats.