Canadian Medical Protective Association, Department of Safe Medical Care Research, Ottawa, Ontario, Canada.
Canadian Medical Protective Association, Department of Safe Medical Care Research, Ottawa, Ontario, Canada; Faculty of Medicine, Department of Medicine and the School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
J Adolesc Health. 2024 Nov;75(5):750-756. doi: 10.1016/j.jadohealth.2024.06.026. Epub 2024 Aug 16.
Adolescent and young adult patients occupy a clinically transitional space between pediatric and adult care. Youth with chronic conditions and special healthcare needs may have trouble accessing and receiving appropriate care in this transition, which may lead to patient safety issues and medicolegal risks for physicians. The objectives of this article were to explore patient safety issues and identify medicolegal risks for physicians.
A national repository was retrospectively searched for medicolegal cases (MLCs) involving complaints from youth. The study included MLCs closed at the Canadian Medical Protective Association between 2013 and 2022 involving youth. The study participants were adolescents and young adults aged ≥ 15 and ≤ 21 years with medical complexity. The frequencies and proportions of patient safety events and medicolegal risks for physicians were calculated by exploring factors that contributed to each incident using established frameworks.
A total of 182 eligible MLCs were identified. Of 206 involved physicians, 55 were psychiatrists. The most common reasons for patient complaints were deficient assessment, diagnostic error, and communication breakdown with the patient and/or family. More than half of the cases were related to a harmful incident. Peer experts reviewed the cases and identified factors such as a deficient assessment, a failure to perform a test or intervention, failure to refer the patient, and insufficient provider knowledge/skill as contributing to the patient safety event.
The impact of our findings is to identify gaps in care delivery to youth that can inform practitioners of ways to mitigate the gaps and improve patient care and health outcomes.
青少年和青年患者在儿科和成人护理之间占据了临床过渡空间。患有慢性疾病和特殊医疗需求的年轻人在这种过渡中可能难以获得和接受适当的护理，这可能导致患者安全问题和医生的医疗法律风险。本文的目的是探讨患者安全问题并确定医生的医疗法律风险。
回顾性地从一个国家知识库中搜索涉及青年投诉的医疗法律案件（MLC）。该研究包括 2013 年至 2022 年间在加拿大医疗保护协会结案的涉及青年的 MLC。研究参与者为患有复杂疾病的年龄在 15 岁及以上和 21 岁以下的青少年和青年。通过使用既定框架探讨导致每个事件的因素，计算了患者安全事件和医生医疗法律风险的频率和比例。
确定了 182 份符合条件的 MLC。在 206 名涉案医生中，有 55 名是精神科医生。患者投诉的最常见原因是评估不足、诊断错误以及与患者和/或家属的沟通中断。超过一半的病例与有害事件有关。同行专家审查了这些案件，并确定了评估不足、未能进行检查或干预、未能转介患者以及提供者知识/技能不足等因素是导致患者安全事件的原因。
我们研究结果的影响在于确定了向青年提供护理方面的差距，这可以为从业者提供减轻这些差距和改善患者护理和健康结果的方法。
