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Bergamin E, Fiorillo A, Grassi VM, Lodise M, Vetrugno G, De-Giorgio F. Medical Professional Liability in Obstetrics and Gynecology: A Pilot Study of Criminal Proceedings in the Public Prosecutor's Office at the Court of Rome. Healthcare (Basel) 2023; 11:healthcare11091331. [PMID: 37174872 PMCID: PMC10178439 DOI: 10.3390/healthcare11091331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- and Gynecology-related medical professional liability prosecutions within the General Register of Criminal Records of the Rome Public Prosecutor's Office between the years 2000 and 2014. The number of prosecutions increased steadily in the years 2000-2005, with varying trends in the following years. A total of 727 healthcare professionals were involved in criminal charges, and most prosecuted crimes were related to Articles 590 and 589 of the Italian Penal Code, followed by violations of Article 17 of Law 194/78. In most cases, filing was requested and granted without opposition. In 95 cases, an expert witness was appointed by the Court, and in 68 cases, the technical consultants of the State Prosecutor found culpable conduct. Public hospitals, private nursing homes and outpatient clinics, or private practices were mostly involved; in 45% of the cases, the physicians were hospital employees. In this setting, Italy is prepared to introduce new measures and regulations to address the issues posed by defensive medicine and charges of professional liability for healthcare providers.
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Affiliation(s)
- Eva Bergamin
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Annamaria Fiorillo
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Vincenzo M Grassi
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Risk Management Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Maria Lodise
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Risk Management Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Fabio De-Giorgio
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
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Ergonomic Challenges Inherent in Neonatal Resuscitation. CHILDREN-BASEL 2019; 6:children6060074. [PMID: 31163596 PMCID: PMC6617094 DOI: 10.3390/children6060074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022]
Abstract
Neonatal resuscitation demands that healthcare professionals perform cognitive and technical tasks while working under time pressure as a team in order to provide efficient and effective care. Neonatal resuscitation teams simultaneously process and act upon multiple data streams, perform ergonomically challenging technical procedures, and coordinate their actions within a small physical space. An understanding and application of human factors and ergonomics science broadens the areas of need in resuscitation research, and will lead to enhanced technologies, systems, and work environments that support human limitations and maximize human performance during neonatal resuscitation.
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Austin N, Kristensen-Cabrera A, Sherman J, Schwandt D, McDonald A, Hedli L, Sie L, Lipman S, Daniels K, Halamek LP, Lee HC. Analyzing the heterogeneity of labor and delivery units: A quantitative analysis of space and design. PLoS One 2018; 13:e0209339. [PMID: 30586446 PMCID: PMC6306211 DOI: 10.1371/journal.pone.0209339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 12/04/2018] [Indexed: 12/29/2022] Open
Abstract
This study assessed labor and delivery (L&D) unit space and design, and also considered correlations between physical space measurements and clinical outcomes. Design and human factors research has increased standardization in high-hazard industries, but is not fully utilized in medicine. Emergency department and intensive care unit space has been studied, but optimal L&D unit design is undefined. In this prospective, observational study, a multidisciplinary team assessed physical characteristics of ten L&D units. Design measurements were analyzed with California Maternal Quality Care Collaborative (CMQCC) data from 34,161 deliveries at these hospitals. The hospitals ranged in delivery volumes (<1000–>5000 annual deliveries) and cesarean section rates (19.6%-39.7%). Within and among units there was significant heterogeneity in labor room (LR) and operating room (OR) size, count, and number of configurations. There was significant homogeneity of room equipment. Delivery volumes correlated with unit size, room counts, and cesarean delivery rates. Relative risk of cesarean section was modestly increased when certain variables were above average (delivery volume, unit size, LR count, OR count, OR configuration count, LR to OR distance, unit utilization) or below average (LR size, OR size, LR configuration count). Existing variation suggests a gold standard design has yet to be adopted for L&D. A design-centered approach identified opportunities for standardization: 1) L&D unit size and 2) room counts based on current or projected delivery volume, and 3) LR and OR size and equipment. When combined with further human factors research, these guidelines could help design the L&D unit of the future.
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Affiliation(s)
- Naola Austin
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
- * E-mail:
| | - Alexandria Kristensen-Cabrera
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Jules Sherman
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Doug Schwandt
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Allison McDonald
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Laura Hedli
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Lillian Sie
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Steven Lipman
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Kay Daniels
- Department of Obstetrics & Gynecology, Maternal Fetal Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Lou P. Halamek
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Henry C. Lee
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California, United States of America
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Tilma J, Nørgaard M, Mikkelsen KL, Johnsen SP. Existing data sources for clinical epidemiology: the Danish Patient Compensation Association database. Clin Epidemiol 2015; 7:347-53. [PMID: 26229505 PMCID: PMC4514350 DOI: 10.2147/clep.s84162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Any patient in the Danish health care system who experiences a treatment injury can make a compensation claim to the Danish Patient Compensation Association (DPCA) free of charge. The aim of this paper is to describe the DPCA database as a source of data for epidemiological research. Data to DPCA are collected prospectively on all claims and include information on patient factors and health records, system factors, and administrative data. Approval of claims is based on injury due to the principle of treatment below experienced specialist standard or intolerable, unexpected extensiveness of injury. Average processing time of a compensation claim is 6–8 months. Data collection is nationwide and started in 1992. The patient’s central registration system number, a unique personal identifier, allows for data linkage to other registries such as the Danish National Patient Registry. The DPCA data are accessible for research following data usage permission and make it possible to analyze all claims or specific subgroups to identify predictors, outcomes, etc. DPCA data have until now been used only in few studies but could be a useful data source in future studies of health care-related injuries.
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Affiliation(s)
- Jens Tilma
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Milland M, Mikkelsen KL, Christoffersen JK, Hedegaard M. Severe and fatal obstetric injury claims in relation to labor unit volume. Acta Obstet Gynecol Scand 2015; 94:534-41. [DOI: 10.1111/aogs.12606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Milland
- Department of Obstetrics; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | | | | | - Morten Hedegaard
- Department of Obstetrics; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
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