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Di Fazio N, Scopetti M, Delogu G, La Russa R, Foti F, Grassi VM, Vetrugno G, De Micco F, De Benedictis A, Tambone V, Rinaldi R, Frati P, Fineschi V. Analysis of Medico-Legal Complaint Data: A Retrospective Study of Three Large Italian University Hospitals. Healthcare (Basel) 2023; 11:healthcare11101406. [PMID: 37239691 DOI: 10.3390/healthcare11101406] [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: 03/05/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Identifying hospital-related critical, and excellent, areas represents the main goal of this paper, in both a national and local setting. Information was collected and organized for an internal company's reports, regarding civil litigation that has been affecting the hospital, to relate the obtained results with the phenomenon of medical malpractice on a national scale. This is for the development of targeted improvement strategies, and for investing available resources in a proficient way. (2) Methods: In the present study, data from claims management in Umberto I General Hospital, Agostino Gemelli University Hospital Foundation and Campus Bio-Medico University Hospital Foundation, from 2013 to 2020 were collected. A total of 2098 files were examined, and a set of 13 outcome indicators in the assessment of "quality of care" was proposed. (3) Results: From the total number, only 779 records (37.1%) were attributable to the categories indexable for the present analysis. This data highlights how, following a correct and rigorous categorization of hospital events, it is possible to analyze these medico-legal aspects using a small number of indicators. Furthermore, it is important to consider how a consistent percentage of remaining events was difficult to index, and was also of poor scientific interest. (4) Conclusions: The proposed indicators do not require standards to be compared to, but provide a useful instrument for comparative purposes. In fact, in addition to comparative assessment between different business realities distributed throughout the territory, the use of outcome indicators allows for a longitudinal analysis evaluating the performance of an individual structure over time.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Federica Foti
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo M Grassi
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco De Micco
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus 12 Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vittoradolfo Tambone
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus 12 Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Raffaella Rinaldi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
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Padovano M, Scopetti M, Tomassi R, Manetti F, D'Errico S, Santurro A, De Toma G, Frati P, Miccoli P, Fineschi V. Mapping complications in thyroid surgery: statistical data are useful for medico-legal management of a recurrent safety issue. Updates Surg 2022; 74:1725-1732. [PMID: 36028654 PMCID: PMC9481495 DOI: 10.1007/s13304-022-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022]
Abstract
Abstract Quality of care assessment is a crucial tool for patient safety implementation. Litigation relating to thyroid surgery is one of the most represented sectors also due to the continuous increase in the number of thyroid interventions. Given the incidence of the problem, the present study aims to outline an operational methodology for risk mapping and litigation management in thyroid surgery. The study was conducted through the analysis of data collected at Umberto I General Hospital in Rome from 2007 to 2018. All thyroid surgery claims were included and, subsequently, a descriptive statistical analysis of the categorical variables was performed with the representation of frequencies in absolute terms and as a percentage. The results obtained show that in 94% of cases (44 cases) the reported event consists of incorrect treatment. The most frequent adverse events were identified in unilateral or bilateral recurrent nerve lesions (31; 70%); incomplete removal of the thyroid gland (6; 14%), post-surgical hypoparathyroidism (4; 9%), aesthetic damage secondary to surgical scars (2; 5%), dental avulsion during intubation maneuvers (1; 2%). The experience derived from the risk mapping through management of thyroid claims proved it to be a reactive tool of considerable importance in clinical governance. The promotion of measures aimed at improving the satisfaction of some critical parameters identified in the litigation management activity such as adherence to the indications for surgery, the preoperative diagnostic path, and the adequacy of the surgical report allows to further implement the quality of care in the surgical treatment of thyroid pathology. Graphical Abstract ![]()
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Affiliation(s)
- Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Matteo Scopetti
- Department of Medical, Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189, Rome, Italy
| | - Raoul Tomassi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, 34149, Trieste, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Salerno, Italy.
| | - Giorgio De Toma
- Department of Surgery, Sapienza University of Rome, 00161, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126, Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
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Bolcato M, Rodriguez D, Aprile A. Guiding Principles for Surgical Pathways: A Tool for Improving Outcomes and Patient Safety. Front Public Health 2022; 10:869607. [PMID: 35462846 PMCID: PMC9024031 DOI: 10.3389/fpubh.2022.869607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Surgical activity is an important aspect for the management of health and safety processes and from an organizational perspective is one of the most complex activities performed in hospitals. It is often a defining and high value feature for any healthcare facility while being one of the most high-risk procedures for patients with the highest number of avoidable adverse events. To ensure effective management of surgical pathways, they need to be considered from the perspective of clinical governance which takes a global approach to planning and management with the goal of improving safety and quality for patients. This paper contains the main features of this objective outlined within the document issued subsequent to the State-Regional Italian Government conference. This regulatory effort includes effective recommendations to make surgical pathways safer and more efficient with particular reference to lean management, patient blood management and patient safety.
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D'Errico S, Zanon M, Radaelli D, Padovano M, Santurro A, Scopetti M, Frati P, Fineschi V. Medication Errors in Pediatrics: Proposals to Improve the Quality and Safety of Care Through Clinical Risk Management. Front Med (Lausanne) 2022; 8:814100. [PMID: 35096903 PMCID: PMC8795662 DOI: 10.3389/fmed.2021.814100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Medication errors represent one of the most common causes of adverse events in pediatrics and are widely reported in the literature. Despite the awareness that children are at increased risk for medication errors, little is known about the real incidence of the phenomenon. Most studies have focused on prescription, although medication errors also include transcription, dispensing, dosage, administration, and certification errors. Known risk factors for therapeutic errors include parenteral infusions, oral fluid administration, and tablet splitting, as well as the off-label use of drugs with dosages taken from adult literature. Emergency Departments and Intensive Care Units constitute the care areas mainly affected by the phenomenon in the hospital setting. The present paper aims to identify the risk profiles in pediatric therapy to outline adequate preventive strategies. Precisely, through the analysis of the available evidence, solutions such as standardization of recommended doses for children, electronic prescribing, targeted training of healthcare professionals, and implementation of reporting systems will be indicated for the prevention of medication errors.
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Affiliation(s)
- Stefano D'Errico
- Department of Medicine, Surgery, and Health, University of Trieste, Trieste, Italy
| | - Martina Zanon
- Department of Medicine, Surgery, and Health, University of Trieste, Trieste, Italy
| | - Davide Radaelli
- Department of Medicine, Surgery, and Health, University of Trieste, Trieste, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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