Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
CRICO/Risk Management Foundation of the Harvard Medical Institutions, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2019 Mar 15;103(4):801-808. doi: 10.1016/j.ijrobp.2018.11.009. Epub 2018 Nov 13.
Medical errors in radiation oncology (RO) practice have received significant national attention over the last decade. Medical errors can lead to malpractice cases. Better characterizing these events can educate providers with the goal of improving patient care.
The Controlled Risk Insurance Company Strategies' Comparative Benchmarking System (CBS) represents approximately 30% of all closed US malpractice cases and includes the experience of more than 30 academic hospitals. Registered nurses trained as clinical taxonomy specialists code each case, and individual case-level details are available. Practicing radiation oncologists extracted all closed RO cases from years 2005 to 2014 and subgrouped them by patient allegation category, clinical injury severity, care setting and academic affiliation, disease site and natural history, treatment modality, and contributing factor. Within categories, χ tests were used to test for the variables' association with an indemnity payment.
RO was the primary service in 102 closed cases (0.2% of all cases in the CBS), accounting for $13,323,578 in indemnity payments (0.1% of all payments in the CBS). The median indemnity payment was $100,000. Head-and-neck and central nervous system tumors accounted for 23.9% and 10.9% of all RO cases, respectively, and 41.3% and 31.4% of all indemnity payments, respectively. Benign diseases and brachytherapy were involved in 12.0% and 15.2% of cases, respectively. Cases involving benign disease (P = .009), treatment of the wrong site (P = .001), or treatment using the wrong dose (P < .001) were all associated with indemnity payments. The top 5 most expensive cases accounted for nearly 80% of all indemnity payments, and all involved head-and-neck, central nervous system, benign, or brachytherapy cases.
We found that although closed malpractice cases involving RO are rare events, certain populations may be overrepresented in closed claims. These data can help inform providers and systems with the goal of ultimately improving patient safety.
在过去十年中，放射肿瘤学（RO）实践中的医疗失误受到了国家的高度关注。医疗失误可能导致医疗事故案件。更好地描述这些事件可以为提供者提供教育，以期改善患者护理。
控制风险保险公司战略的比较基准系统（CBS）代表了所有已关闭的美国医疗事故案件的约 30%，并包括 30 多家学术医院的经验。经过培训的注册护士作为临床分类专家对每个病例进行编码，并且可以获得每个病例的详细信息。执业放射肿瘤学家从 2005 年至 2014 年提取了所有已关闭的 RO 病例，并根据患者指控类别、临床伤害严重程度、护理环境和学术隶属关系、疾病部位和自然病史、治疗方式以及促成因素对其进行分组。在各分类中，使用卡方检验来检验变量与赔偿支付之间的关系。
RO 是 102 例已关闭病例（CBS 中所有病例的 0.2%）的主要服务项目，赔偿支付额为 13323578 美元（CBS 中所有支付额的 0.1%）。赔偿支付的中位数为 100000 美元。头颈部和中枢神经系统肿瘤分别占所有 RO 病例的 23.9%和 10.9%，占所有赔偿支付的 41.3%和 31.4%。良性疾病和近距离放射治疗分别涉及 12.0%和 15.2%的病例。涉及良性疾病的病例（P=0.009）、治疗错误部位的病例（P=0.001）或使用错误剂量治疗的病例（P<0.001）均与赔偿支付相关。前 5 例最昂贵的病例占所有赔偿支付的近 80%，均涉及头颈部、中枢神经系统、良性或近距离放射治疗病例。
我们发现，尽管涉及 RO 的已关闭医疗事故案件是罕见事件，但某些人群在已关闭的索赔中可能占比较大。这些数据可以为提供者和系统提供信息，最终目标是提高患者安全性。
