Increasing Liability Premiums in Obstetrics - Analysis, Effects and Options

Professional responsibility in obstetric-gynecological nursing: Update of the case law of the High Court of Justice of Andalusia (Spain)

BACKGROUND

Obstetric-Gynecological Nursing is articulated as one of the specialities with the greatest responsibility in the field of health care, due to the involvement of being in care not only for the life of the pregnant woman, but also for the future neonate. Settling down as a profession with a high number of legal claims, there are not many studies in Spain on legal claims in the field of Nursing in general, and Obstetric-Gynecological Nursing in particular.

METHODS

Retrospective analysis of judgments against midwives in the period from 2010 to the present through the CENDOJ database, with the aim of searching for criminal, civil and contentious-administrative judgments. Quality was assessed using the STROBE critical appraisal tool for observational studies.

RESULTS

19 judgments were selected from the 197 found that were related to the objective of the study. Fifty-three percent of the judgment analyzed resulted in acquittals, while the remaining 47% were upheld to varying degrees. Most of them were motivated damage to the newborn (79%), processed entirely through the contentious-administrative route.

CONCLUSIONS

Most of the legal claims in the field of Obstetric-Gynecological Nursing are related to adverse events with fetal damage, most of them receiving higher monetary compensation as the contentious-administrative route is the jurisdiction with the highest number of claims filed, due to breaches of the lex artis ad hoc.

Defensive medicine and cesarean sections in Brazil

Brazil has a high rate of cesarean sections (CS) that cannot be solely justified by women's clinical conditions; thus, other causes, for example, CS on maternal request and physicians' fear of litigation as possible influencing factors, cannot be overlooked.This study aimed to identify through a survey whether Brazilian gynecologists and obstetricians (GOs) perform defensive CS.In this cross-sectional, descriptive study, a questionnaire was administered. The target population comprised of GOs who were members of premier Brazilian professional associations of gynecology and obstetrics. A total of 403 GOs participated in the survey using an obstetrics questionnaire about litigation and defensive medicine (DM). Statistical analyses were performed on pairs of variables to determine the risk factors of performing CS due to concerns of complications during vaginal delivery and to avoid lawsuits.The mean age of the GOs was 47.7 years who were mostly female (58.3%) and having worked professionally in both public and private sectors (71.7%). Of all participants, 80.6% had been sued or knew an obstetrician who had been sued. The obstetricians who had been sued or who knew a colleague that had been sued exhibited a significantly higher likelihood of performing defensive CS than physicians who had not been sued or did not know physicians who had been sued. The perception of a higher risk of lawsuits against obstetricians influenced the practice of DM and led to a more than six-fold increase in CSs in specialists with this perception compared to specialists who did not believe the presence of an increased risk of litigation in obstetrics existed.The majority of Brazilian GOs perform defensive CS. It is important to consider DM as one of the causes of high CS rates in Brazil and include it in the development of public policies to reduce these CS rates.

Midwives' perception of patient safety culture-A qualitative study

OBJECTIVE

To explore midwives' experiences with and perceptions of patient safety culture in the German-speaking countries.

DESIGN AND SETTING

Semi-structured interviews with midwives were conducted between December 2013 and March 2014, whereby the narrative nature of the questions on patient safety culture provided the space for the interviewed midwives to express their own wishes and thoughts freely. The interviews were recorded and transcribed, and the transcripts were anonymized with respect to personal and institutional names. The analysis of the transcripts was based on the methods of qualitative content analysis with the goal to consider all of the remarks with open coding, following a strictly inductive approach. Data analysis and categorization was performed using the software MAXQDA Release 12.2.1.

PARTICIPANTS

14 midwives from Austria, Germany and Switzerland.

FINDINGS

The interviewed midwives provided insights into their thoughts and experiences on factors that promote and inhibit patient safety culture as well as superordinate topics related to patient safety culture in general. Their statements were assigned to seven main categories; (i) institutional circumstances, (ii) role of the management, (iii) interprofessional factors, (iv) meetings, (v) education and training, and (vi) psychosocial aspects. Moreover, the majority of statements assigned to these categories additionally related to two overarching core categories, communication and knowledge / skills.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

It appears that patient safety culture is a personal matter for the majority of the participating midwives. However, it seems that at least at some institutions a discrepancy between the perceived importance of patient safety culture and an incomplete implementation into everyday work exists. A natural way of dealing with patient safety culture and an open blame-free discussion of critical incidences rely on the implementation of institutional circumstances that promote education, training as well as intra- and interprofessional exchange and transparent clear responsibilities.