Grassi Simone, Grazzini Maddalena, Guerini Marta, Bertana Giorgio, Pompeo Linda, Paolini Diana, Niccolini Fabrizio, Focardi Martina, Pinchi Vilma
Department of Health Sciences, Forensic Medical Sciences, University of Florence, Florence, Italy.
Hospital Infection Prevention and Control Unit, Florence Careggi University Hospital, Florence, Italy.
Front Med (Lausanne). 2024 Aug 27;11:1430625. doi: 10.3389/fmed.2024.1430625. eCollection 2024.
Healthcare-associated infections are the main reported adverse event in healthcare, with significant economic costs that include those caused by medical malpractice claims. In Italy, there is a fault-based compensation system, but in this specific field, the burden of proof on the hospitals is particularly heavy. Hence, we aimed to verify the economic impact of the inclusion of experts in hospital infection surveillance into internal committees for claims assessment and to evaluate what would have been the economic impact of a mandatory no-fault system rather than the current system.
We compared two 4-year periods (T1: 2015-2018 and T2: 2019-2022), investigating the medical malpractice claims related to healthcare-associated infections in a large tertiary public hospital in Florence, Italy. Decisions of the internal committee, evolutions of the claims after the decision, and conclusions of the claims were registered. No-fault system simulations were used to evaluate the cost-effectiveness of the model.
We observed a decrease in the number of claims after the implementation of infection prevention and control (IPC) experts into the committee (a 24% decrease in rejections and a 19% increase in admissions). We found a 6806.98 euros difference (not statistically significant) in compensations in T1 and T2. Moreover, our simulations found that a no-fault compensation system - if alternative to the traditional fault-based approach - could lead to gains or losses for the plaintiffs depending on the approach chosen. (We observed a 52% mean decrease in compensations with a 150000 euros maximal indemnity and a 134% mean increase with an indemnity tailored considering also life expectancy).
Introducing experts in IPC into hospital committees for medico-legal claims management has proven to be cost-effective, offering a no-fault compensation system as an alternative to the traditional fault-based approach, supported by a properly evaluated maximal indemnity. Due to the limitations of our models, multicentric studies are recommended to verify our results.
医疗相关感染是医疗保健领域报告的主要不良事件，会产生巨大的经济成本，其中包括医疗事故索赔造成的成本。在意大利，存在基于过错的赔偿制度，但在这个特定领域，医院的举证责任尤其沉重。因此，我们旨在验证将医院感染监测专家纳入内部索赔评估委员会的经济影响，并评估强制实行无过错制度而非现行制度会产生怎样的经济影响。
我们比较了两个4年时间段（T1：2015 - 2018年和T2：2019 - 2022年），调查了意大利佛罗伦萨一家大型三级公立医院中与医疗相关感染有关的医疗事故索赔。记录了内部委员会的决定、决定后索赔的进展情况以及索赔的结论。使用无过错制度模拟来评估该模型的成本效益。
我们观察到在委员会中引入感染预防与控制（IPC）专家后索赔数量有所减少（驳回率降低24%，受理率提高19%）。我们发现T1和T2期间的赔偿金额存在6806.98欧元的差异（无统计学意义）。此外，我们的模拟发现，无过错赔偿制度——如果替代传统的基于过错的方法——根据所选择的方法，可能会给原告带来收益或损失。（我们观察到，在最高赔偿额为150000欧元时，赔偿平均减少52%；在考虑预期寿命进行定制赔偿时，赔偿平均增加134%）。
事实证明，将IPC专家引入医院的医疗法律索赔管理委员会具有成本效益，提供了一种无过错赔偿制度作为传统基于过错方法的替代方案，并辅以经过适当评估的最高赔偿额。由于我们模型的局限性，建议进行多中心研究以验证我们的结果。
