A REVIEW OF LAWSUITS RELATED TO POINT-OF-CARE EMERGENCY ULTRASOUND APPLICATIONS

Does point-of-care ultrasound examination by the general practitioner lead to inappropriate care? A follow-up study

BACKGROUND

The use of point-of-care ultrasound (POCUS) in general practice increases, but little is known about potential unintended findings and harms to patients. Information regarding such unwanted effects may be obtained by evaluating the medical records of patients who have been scanned by their general practitioner.

OBJECTIVE

To identify and characterize re-consultations related to POCUS use in general practice, potential misdiagnosis, overdiagnosis, and incidental findings, and to compare potentially troublesome cases to GPs' scanning competence and type of ultrasound device.

DESIGN AND SETTING

Professors in general practice with extensive experience in both research and quality assurance in general practice did a blinded review of prospectively collected routine electronic medical record data combined with cross-sectional data collected in relation to POCUS examinations.

SUBJECTS

Twenty general practitioners collected data on 564 patients examined with POCUS in primary care.

MAIN OUTCOME MEASURES

International standards for the classification of adverse events and incidental findings were used. First, research assistants identified all re-consultations described in the medical records that were related to the primary health complaint at the index consultation. Second, these re-consultations were classified by the medical experts in terms of seriousness and relation to the POCUS examination performed at the index consultation. In addition, the experts identified possible misdiagnosis, possible overdiagnosis, and incidental findings. Finally, identified cases were discussed in terms of appropriateness and described narratively.

RESULTS

Medical records of 564 patients were reviewed. A low risk of possible misdiagnosis (5.3%), potential overdiagnosis (0.7%), and incidental findings (0.7%) were found. Eleven POCUS-related re-consultations were identified and described.

CONCLUSION

POCUS scanning performed by general practitioners was generally safe, but it can result in unnecessary examinations and potential harm in a few cases. Certain areas, e.g. pelvic scans that included the ovaries, may especially be prone to misdiagnosis.

TRIAL REGISTRATION NUMBER

NCT03375333.

Point-Of-Care Ultrasound in Emergency Departments in Australia/New Zealand: An Emergency Physician's Perspective

This brief overview of the current state of clinician performed focused ultrasound (Emergency PoCUS) by emergency practitioners in Australia/New Zealand (ANZ) has touched on its history, scope of practice both mandated and context-dependent, complex embedding in clinical diagnostic reasoning and range of governance issues. It is the author's hope that an ongoing understanding and interplay between the three professional groups most closely involved in the use of ultrasound to improve patient care and health-care flow can continue to work closely together for the ultimate benefit of patients in multiple contexts in ANZ and beyond.

Principles and Practice of Internal Medicine Point-of-Care Ultrasound

While point-of-care ultrasound (POCUS) use is expanding within Internal Medicine, basic yet important practices and key infrastructure are frequently underutilized. This is appropriately raising concerns that patients may be unintentionally harmed by POCUS. To mitigate this risk, this article advocates for ensuring POCUS users have adequate training to include understanding limitations and pitfalls arising from acquisition, interpretation, and clinical integration. It is also important to build infrastructure to allow for ongoing monitoring and quality assurance with an emphasis on transparency and objectivity of the clinician's POCUS findings. This will ensure the safe and effective integration of POCUS in Internal Medicine.

Pitfalls in Point-of-Care Ultrasound

Errors and pitfalls associated with the performance of point-of-care ultrasound (POCUS) are common and can stem from errors in image acquisition, interpretation, and clinical integration. In this article, the author discuss the technical and cognitive mechanisms involved and propose a framework in systematically approaching potential errors in POCUS, as well as strategies to mitigate them.

Point-of-care ultrasound in nephrology: A private practice viewpoint

Point-of-care ultrasound (POCUS) is a limited ultrasound examination performed by the clinician at the bedside, emerging as a complement to physical examination across various medical specialties. In the field of nephrology, its integration has been gradual, primarily limited to guiding procedures like temporary dialysis catheter placement or, in some cases, diagnostic kidney ultrasounds. In reality, the assessment of hemodynamic status at the bedside holds immense value for nephrologists, yet there exists limited awareness among practitioners regarding its implementation. While there is a growing trend towards incorporating multi-organ POCUS training in fellowship programs, private practice nephrologists remain relatively uninformed. This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice, demonstrating its effectiveness in diverse clinical settings, ranging from medical wards to outpatient dialysis units. Additionally, we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.

Evaluation of problems arising in emergency services from the perspectives of medical and criminal law: The example of Türkiye

Introduction

In recent years, the field of medical malpractice has attracted growing attention, and despite the long history of research in this area, aspects of this phenomenon remain unexplored. In this paper, we aimed to explore the issue of medical malpractice, focusing on cases involving healthcare professionals working in emergency services in Türkiye. We examine the surge in medical malpractice lawsuits, the consequences of such cases, and the prevalence of criminal liability faced by healthcare professionals.

Materials and methods

A comprehensive analysis of healthcare-related cases from 2017 to 2022 was carried out using the electronic decision database "LEGALBANK." We scrutinized these cases from both medical and criminal law perspectives, aiming to shed light on the complex dynamics of medical malpractice in emergency services.

Results

The findings reveal that professionals in emergency services are confronted with a considerable number of criminal cases. Among these cases, doctors are the most frequently implicated, followed by nurses, midwives, ambulance drivers, and other healthcare professionals. The crimes attributed to these professionals vary but primarily include involuntary manslaughter, misuse of public duty, forgery of documents, and reckless injury.

Discussion

In Türkiye, there is a notable prevalence of investigations conducted in emergency services and criminal cases involving healthcare professionals in this field. This dual prominence underscores the unique significance of examining medical malpractice from the perspectives of both criminal law and medicine within the Turkish context. This study categorizes the multifaceted challenges of medical malpractice as human-related, system-related, and legal, offering valuable insights into the intricate landscape of this phenomenon in Türkiye's emergency services.

Conclusion

This research contributes to a deeper understanding of medical malpractice, particularly its criminal dimensions in the Turkish context, and thereby calls for improved healthcare, enhanced patient safety, and error prevention in emergency settings.

Medico-legal risks of point-of-care ultrasound: a closed-case analysis of Canadian Medical Protective Association medico-legal cases

BACKGROUND

Point-of-care ultrasound (POCUS) has become a core diagnostic tool for many physicians due to its portability, excellent safety profile, and diagnostic utility. Despite its growing use, the potential risks of POCUS use should be considered by providers. We analyzed the Canadian Medical Protective Association (CMPA) repository to identify medico-legal cases arising from the use of POCUS.

METHODS

We retrospectively searched the CMPA closed-case repository for cases involving diagnostic POCUS between January 1st, 2012 and December 31st, 2021. Cases included civil-legal actions, medical regulatory authority (College) cases, and hospital complaints. Patient and physician demographics, outcomes, reason for complaint, and expert-identified contributing factors were analyzed.

RESULTS

From 2012 to 2021, there were 58,626 closed medico-legal cases in the CMPA repository with POCUS determined to be a contributing factor for medico-legal action in 15 cases; in all cases the medico-legal outcome was decided against the physicians. The most common reasons for patient complaints were diagnostic error, deficient assessment, and failure to perform a test or intervention. Expert analysis of these cases determined the most common contributing factors for medico-legal action was failure to perform POCUS when indicated (7 cases, 47%); however, medico-legal action also resulted from diagnostic error, incorrect sonographic approach, deficient assessment, inadequate skill, inadequate documentation, or inadequate reporting.

CONCLUSIONS

Although the most common reason associated with the medico-legal action in these cases is failure to perform POCUS when indicated, inappropriate use of POCUS may lead to medico-legal action. Due to limitations in granularity of data, the exact number of civil-legal, College cases, and hospital complaints for each contributing factor is unavailable. To enhance patient care and mitigate risk for providers, POCUS should be carefully integrated with other clinical information, performed by providers with adequate skill, and carefully documented.

Normology: Is it Time to Rethink Point-of-Care Ultrasound Training?

Point-of-care ultrasound (PoCUS) is increasingly being adopted by clinicians to augment their clinical examination and aid procedures. Evidence-based clinical practice guidelines now support many aspects of PoCUS practice. As a result, more and more medical schools are integrating PoCUS into their curricula, creating a significant demand for training resources. All training must ensure that trainees have the appropriate knowledge, skills and behaviour to enable the clinical integration of PoCUS. The transition from supervised to unsupervised practice is an important step in PoCUS, but should not be confused with expertise. At the start of clinical practice, confirming that something is not normal is probably enough, and trainees can subsequently improve their PoCUS diagnostic accuracy at the bedside during clinical rotations. Our hypothesis is that competency can be achieved without the need to scan patients suspected or suffering from the target pathology. This would enable most of the training to be carried out outside the clinical environment, using volunteers in planned sessions. These planned sessions will be able to accommodate a larger number of trainees and may facilitate collaboration between specialties. When patients are scanned in the clinical environment, trainees should have acquired a good level of competence beforehand. In summary, normology principles could help PoCUS trainees, at the start of their training, to acquire the knowledge, skills and behaviour necessary to achieve a level of competency allowing them to proceed to unsupervised practice. Initially confirming whether something is normal or not is enough. Nevertheless, further research should be conducted to support this concept, and its impact on PoCUS teaching in clinical practice.

Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology

Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.