Centra Medical Group, Lynchburg, Virginia.
Biostatics, Evaluation, Collaboration, Consultation, and Analysis Lab, University of Pennsylvania, Philadelphia, Pennsylvania.
J Midwifery Womens Health. 2022 Mar;67(2):226-234. doi: 10.1111/jmwh.13355. Epub 2022 Mar 29.
This is the third national survey about the incidence of midwifery involvement in malpractice litigation, case outcome, methods of coping, and the influence of fear of liability or actual litigation on midwifery practice and professional liability insurance. Incidence of disciplinary action was also included.
A link to a web-based survey was sent to all American College of Nurse-Midwives members with an active email address in January 2018. Students and associate members were excluded from analysis. Logistic regression was used to identify predictors of involvement in lawsuit.
Of 6199 email links sent, 880 midwives responded (14%). One-third of participants (n = 280, 32%) have been named in at least one lawsuit after a median of 7 years in practice. Claims most often involved intrapartum hospital-based care and resulted from fetal heart rate interpretation. The most common outcome of a case was settlement prior to court or arbitration (n = 117, 42%). Significant predictors of litigation included older age of the midwife and region of practice (increased in Northeastern states, decreased in Midwestern states). Midwives' most common source of emotional support was their attorney. Only 6% (n = 53) of participants experienced disciplinary action against their state license. Half of the actions by a state governing board were unrelated to a lawsuit.
Midwives may experience litigation the longer they are in practice, but there has not been a significant change in the incidence since the previous survey in 2009. More resources and education are needed for midwives to provide adequate peer support to colleagues following adverse events or when named in a lawsuit. Continued education is also needed for midwives regarding types of professional liability insurance, affordability, and how policy terms and limits influence clinical practice.
这是第三次全国性调查，调查内容为助产士在医疗事故诉讼中的参与率、案件结果、应对方法，以及对助产实践和职业责任保险的恐惧或实际诉讼的影响。还包括纪律处分的情况。
2018 年 1 月，向所有美国护理助产士学院的会员发送了一个基于网络的调查链接，前提是他们的电子邮件地址处于活跃状态。学生和准会员不包括在分析中。使用逻辑回归来确定参与诉讼的预测因素。
在发送的 6199 个电子邮件链接中，有 880 名助产士做出回应（14%）。三分之一的参与者（n=280，32%）在中位数为 7 年的实践后至少被起诉过一次。索赔最常涉及分娩期的医院护理，并因胎儿心率解读不当而引起。案件最常见的结果是在法庭或仲裁前和解（n=117，42%）。诉讼的显著预测因素包括助产士年龄较大和所在地区（东北部各州增加，中西部各州减少）。助产士最常见的情感支持来源是他们的律师。只有 6%（n=53）的参与者受到州执照的纪律处分。州监管委员会的一半行动与诉讼无关。
助产士在实践中可能会经历诉讼，自 2009 年上一次调查以来，诉讼的发生率并没有显著变化。在发生不良事件或被起诉时，助产士需要更多的资源和教育，以提供适当的同行支持。还需要对助产士进行有关职业责任保险的类型、负担能力以及政策条款和限额如何影响临床实践的继续教育。
