对创伤患者的错误进行透明且公开的讨论不会增加医疗事故风险。
Transparent and open discussion of errors does not increase malpractice risk in trauma patients.
作者信息
Stewart Ronald M, Corneille Michael G, Johnston Joe, Geoghegan Kathy, Myers John G, Dent Daniel L, McFarland Marilyn, Alley Joshua, Pruitt Basil A, Cohn Stephen M
机构信息
Department of Surgery, University of Texas Health Science Center at San Antonio, University Hospital, 78229, USA.
出版信息
Ann Surg. 2006 May;243(5):645-9; discussion 649-51. doi: 10.1097/01.sla.0000217304.65877.27.
OBJECTIVE
We set out to determine if there is an increased medical malpractice lawsuit rate when trauma patient cases are presented at an open, multidisciplinary morbidity and mortality conference (M&M).
INTRODUCTION
Patient safety proponents emphasize the importance of transparency with respect to medical errors. In contrast, the tort system focuses on blame and punishment, which encourages secrecy. Our question: Can the goals of the patient safety movement be met without placing care providers and healthcare institutions at unacceptably high malpractice risk?
METHODS
The trauma registry, a risk management database, along with the written minutes of the trauma morbidity and mortality conference (M&M) were used to determine the number and incidence of malpractice suits filed following full discussion at an open M&M conference at an academic level I trauma center.
RESULTS
A total of 20,749 trauma patients were admitted. A total of 412 patients were discussed at M&M conference and a total of seven lawsuits were filed. Six of the patients were not discussed at M&M prior to the lawsuit being filed. One patient was discussed at M&M prior to the lawsuit being filed. The incidence of lawsuit was calculated in three groups: all trauma patients, all trauma patients with complications, and all patients presented at trauma M&M conference. The ratio of lawsuits filed to patients admitted and incidence in the three groups is as follows: All Patients, 7 lawsuits/20,479 patients (4.25 lawsuits/100,000 patients/year); M&M Presentation, 1 lawsuit/421 patients (29.6 lawsuits/100,000 patients/year); All Trauma Complications, 7 lawsuits/6,225 patients (14 lawsuits/100,000 patients/year). Patients with a complication were more likely to sue (P < 0.01); otherwise, there were no statistical differences between groups.
CONCLUSIONS
A transparent discussion of errors, complications, and deaths does not appear to lead to an increased risk of lawsuit.
目的
我们旨在确定在开放性多学科发病率与死亡率会议（M&M会议）上汇报创伤患者病例时，医疗事故诉讼率是否会升高。
引言
患者安全倡导者强调医疗差错透明度的重要性。相比之下，侵权责任制度侧重于指责和惩罚，这助长了信息保密。我们的问题是：在不使医护人员和医疗机构面临高得不可接受的医疗事故风险的情况下，能否实现患者安全运动的目标？
方法
利用创伤登记册（一个风险管理数据库）以及创伤发病率与死亡率会议（M&M会议）的书面记录，来确定在一所一级学术创伤中心举行的开放性M&M会议上进行充分讨论后提起的医疗事故诉讼的数量和发生率。
结果
共收治20749例创伤患者。在M&M会议上讨论了412例患者，共提起7起诉讼。其中6例患者在提起诉讼之前未在M&M会议上讨论过。1例患者在提起诉讼之前在M&M会议上讨论过。诉讼发生率按三组计算：所有创伤患者、所有有并发症的创伤患者以及所有在创伤M&M会议上汇报的患者。三组中提起诉讼的患者与收治患者的比例及发生率如下：所有患者，7起诉讼/20479例患者（4.25起诉讼/100000例患者/年）；M&M会议汇报患者，1起诉讼/421例患者（29.6起诉讼/100000例患者/年）；所有创伤并发症患者，7起诉讼/6225例患者（14起诉讼/100000例患者/年）。有并发症的患者起诉的可能性更大（P<0.01）；除此之外，各组之间无统计学差异。
结论
对差错、并发症和死亡进行透明的讨论似乎不会导致诉讼风险增加。
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