妇科医疗中的医疗责任索赔：荷兰妇科索赔的回顾性分析（2005-2022 年）-治疗指征、治疗阶段与医疗事故索赔风险之间是否存在关联？

Medical liability claims in gynaecologic care: retrospective analysis of claims related to gynaecology in the Netherlands (2005-2022) - Is there a connection between treatment indication, phase of treatment and the risk of medical malpractice claims?

机构信息

Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, 6229 HX, the Netherlands.

Care and Public Health Research Institute, Maastricht University Medical Centre+, Maastricht, 6229 HX, The Netherlands.

出版信息

BMC Health Serv Res. 2024 Nov 25;24(1):1465. doi: 10.1186/s12913-024-11943-8.

DOI:10.1186/s12913-024-11943-8

PMID:39587572

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11590291/

Abstract

BACKGROUND

An increased interest in medical liability claims has been noticed. Nevertheless, detailed data on subject of claims and possible factors that contribute to litigation and indemnity payments are scarce and relatively dated. Insight into these data may provide valuable information to prevent both incidents and malpractice claims.

OBJECTIVE

To analyse the subject, outcome and costs of malpractice claims related to gynaecological care and their connection with treatment indications and treatment phases.

DESIGN

A retrospective analysis of malpractice claims related to gynaecology.

SETTING

All claims related to gynaecology, filed and closed by Netherlands' largest liability insurance company, Centramed between 2005 and 2022.

SAMPLE

N = 382.

METHODS

An in-depth analysis of claim files was performed.

RESULTS

A total of 68.6% of the claims were related to perioperative incidents. A total of 88.0% of all claims were related to treatments with a benign indication and only 12.0% were related to malignancies. The share of malignant treatment indications was high for claims related to diagnostic incidents (37.9%), compared to 7.3% for claims related to surgical treatment. Liability was accepted in 22.5% of all claims. The total costs of all claims amount €6,6mlj. Besides the indication for treatment, deficient expectation management (a lack of informed consent) contributes to dissatisfaction and increases the risk of malpractice claims. Finally, an inadequate medical file compromises legal defence and influences the judgement and settlement of malpractice claims.

CONCLUSIONS

There is a connection between treatment indications and treatment phases and the risk of malpractice claims and their outcome.

摘要

背景

人们对医疗责任索赔的兴趣日益增加。然而，有关索赔主题以及可能导致诉讼和赔偿支付的因素的详细数据仍然稀缺且相对陈旧。深入了解这些数据可以为预防事故和医疗事故索赔提供有价值的信息。

目的

分析与妇科护理相关的医疗事故索赔的主题、结果和费用，以及它们与治疗指征和治疗阶段的关系。

设计

对与妇科相关的医疗事故索赔进行回顾性分析。

地点

荷兰最大的责任保险公司 Centramed 在 2005 年至 2022 年间收到和处理的所有与妇科相关的索赔。

样本量

N = 382。

方法

对索赔文件进行深入分析。

结果

总共有 68.6%的索赔与围手术期事件有关。所有索赔中，有 88.0%与良性指征的治疗有关，只有 12.0%与恶性肿瘤有关。与诊断性事件相关的索赔中恶性肿瘤治疗指征的比例较高（37.9%），而与手术治疗相关的索赔中恶性肿瘤治疗指征的比例为 7.3%。在所有索赔中，有 22.5%的责任被认定。所有索赔的总成本为 6600 万欧元。除了治疗指征外，缺乏期望管理（缺乏知情同意）也会导致不满，增加医疗事故索赔的风险。最后，不充分的医疗记录会影响法律辩护，并影响医疗事故索赔的判决和解决。