Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
J Patient Saf. 2021 Dec 1;17(8):576-582. doi: 10.1097/PTS.0000000000000686.
Clinicians may hesitate to advocate for autopsies out of concern for increased malpractice risk if the pathological findings at time of death differ from the clinical findings. We aimed to understand the impact of autopsy findings on malpractice claim outcomes.
Closed malpractice claims with loss dates between 1995 and 2015 involving death related to inpatient care at 3 Harvard Medical School hospitals were extracted from a captive malpractice insurer's database. These claims were linked to patients' electronic health records and their autopsy reports. Using the Goldman classification system, 2 physician reviewers blinded to claim outcome determined whether there was major, minor, or no discordance between the final clinical diagnoses and pathologic diagnoses. Claims were compared depending on whether an autopsy was performed and whether there was major versus minor/no clinical-pathologic discordance. Primary outcomes included percentage of claims paid through settlement or plaintiff verdict and the amount of indemnity paid, inflation adjusted.
Of 293 malpractice claims related to an inpatient death that could be linked to patients' electronic health records, 89 claims (30%) had an autopsy performed by either the hospital or medical examiner. The most common claim allegation was an issue with clinician diagnosis, which was statistically less common in the autopsy group (18% versus 38%, P = 0.001). There was no difference in percentage of claims paid whether an autopsy was performed or not (42% versus 41%, P = 0.90) and no difference in median indemnity of paid claims after adjusting for number of defendants ($1,180,537 versus $906,518, P = 0.15). Thirty-one percent of claims with hospital autopsies performed demonstrated major discordance between autopsy and clinical findings. Claims with major clinical-pathologic discordance also did not have a statistically significant difference in percentage paid (44% versus 41%, P > 0.99) or amount paid ($895,954 versus $1,494,120, P = 0.10) compared with claims with minor or no discordance.
Although multiple factors determine malpractice claim outcome, in this cohort, claims in which an autopsy was performed did not result in more paid outcomes, even when there was major discordance between clinical and pathologic diagnoses.
如果死亡时的病理发现与临床发现不同，临床医生可能会因为担心医疗事故风险增加而不愿提倡进行尸检。我们旨在了解尸检结果对医疗事故索赔结果的影响。
从一家受保的医疗事故保险公司的数据库中提取了 1995 年至 2015 年期间因哈佛医学院三所医院住院患者死亡而导致的医疗事故索赔的封闭索赔记录，这些索赔记录与患者的电子健康记录及其尸检报告相关联。使用 Goldman 分类系统，两位对索赔结果不知情的医生审查员确定最终临床诊断和病理诊断之间是否存在主要、次要或无差异。根据是否进行尸检以及临床-病理差异是否主要或次要/无差异，对索赔进行了比较。主要结局包括通过和解或原告裁决支付的索赔百分比和支付的赔偿金额，经通胀调整后。
在 293 份与住院患者死亡相关的可与患者电子健康记录相关联的医疗事故索赔中，有 89 份索赔（30%）进行了尸检，尸检由医院或法医进行。最常见的索赔指控是临床医生诊断问题，在尸检组中这一比例较低（18%比 38%，P = 0.001）。进行尸检与不进行尸检的索赔支付比例没有差异（42%比 41%，P = 0.90），调整被告人数后，已支付索赔的赔偿中位数也没有差异（$1,180,537 比 $906,518，P = 0.15）。进行医院尸检的 31%的索赔在尸检和临床发现之间存在主要差异。具有主要临床-病理差异的索赔在支付比例（44%比 41%，P > 0.99）或支付金额（$895,954 比 $1,494,120，P = 0.10）方面与次要或无差异的索赔也没有统计学差异。
尽管多种因素决定了医疗事故索赔的结果，但在本队列中，进行尸检的索赔并未导致更多的支付结果，即使临床和病理诊断之间存在主要差异。
