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PubMedDate not supplied

Clinical reminders in ambulatory care.

Computerized reminders are a tool to improve patient care, increase compliance, and reduce medical liability in ambulatory health care. Continuity of care is often hard to achieve given large patient loads, cost containment pressures, and regulatory requirements. Recall reminders prompt patients to make or keep appointments for health maintenance or screening exams. Physician reminders are issued to clinicians at or between visits when their patients have specific screening or diagnostic needs. Reminder systems based on clinical protocols have the added advantage of providing explicit instructions for workup or treatment of abnormal conditions. These reminder systems are especially useful to standardize care in offices with many providers. Implementation of reminder systems is aided by careful staff preparation and resource allocation. Ultimately, reminder systems enhance quality of care, increase patient satisfaction, and reduce costs through improved continuity of care and early detection of serious illness.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Federal mandatory spending caps vital for health care reform.

Rising health spending creates an increasing burden on families, businesses, and government. Federal health spending--chiefly on Medicare and Medicaid--is a major contributor to a budget deficit that threatens to exceed $400 billion. In order to control that deficit, the President and the Congress must cap mandatory spending, excluding Social Security. In turn, policymakers should adopt health reforms to fit spending within the cap including enrolling more consumers in managed care plans, resolving medical liability disputes in arbitration instead of courts, and increasing assessment of research into cost-effective new technology.

Cost Control↗
PubMed1994

Tracking risk in integration.

Healthcare systems rushing into integration may be leaving themselves vulnerable to lawsuits involving medical liability--risk that's often ignored. Winners in the fourth annual Excellence in Healthcare Risk Management Awards show how some providers are addressing that vulnerability.

Awards and Prizes↗
PubMed1989

Is the medical malpractice outlook really improving?

After climbing significantly over the past decade, medical liability insurance rates appear to be moderating as a result of declining frequency and severity of claims from late 1986 through 1988. A "softer" insurance climate with greater underwriting capacity also aided this process. However, experts believe that the moderation of rate increases may be short-lived because of the cyclical nature of the insurance marketplace and the insurer's difficulty in estimating claims and losses.

Forecasting↗
PubMed2000

[Guidelines in clinical practice. Bioethical considerations].

The adoption of guidelines in clinical practice raises questions that can be answered against a background in which professional conduct is compared with deontology, law, and the specific sociocultural context and health policies of institutions. In the scientific community, doubts are raised regarding the relationships between the general recommendations laid down in the Guidelines and the specific nature of every clinical condition; between the "duty of adhering" to Guidelines and the doctor's autonomy, as well as between the adoption, discrepancy and non-adoption of Guidelines and the juridical evaluation of medical liability. The information and individual consent of patients and citizens is of particular importance both with regard to clinical procedures and choices of allocation. In the light of these comments, the authors conclude that Guidelines should not be reduced to a form of automated procedure lacking any responsibility, but should represent a correct synthesis between the objective nature of scientific findings, the subjective condition of the patient and the doctor's autonomy. The application of correctly formulated Guidelines shared by the community means acting in such a way that the "right to health" and "freedom of treatment" can be exercised in respect of shared bioethical principles based on beneficence, autonomy and justice.

Bioethics↗
PubMed2000

[Professional civil responsibility of physicians: towards a modification of the law in the year 2000?].

For more than twenty years, physicians, lawyers, insurers and patients stress the wrong working of civil medical liability in our country. After surveying the most important slacknesses of the current system, the author examines the answers or proposals on the one hand of the jurisprudence and on the other hand of the governing authorities and finally of the scientific sector. The study emphasizes also the current community of interest which leads to implementation of a new law which content is however difficult to define. At last, the author tries to show the most clearly expected modifications and suggests also some practical pieces of advice regarding the evolution of the jurisprudence.

Belgium↗
PubMed2001

The dental digital radiograph.

A discussion of digital radiographs. Shows how the digital radiograph is formed and its many uses. Lists and explains the advantages, that is, it is instantaneous, fewer problems with quality, and can mesh with the computer in the office. The disadvantages are described as well and may include cost, medical liability and storage space. Lastly, it points out the possible future developments that may take place in dentistry with use of this technology.

Computers↗
PubMed2003

When life is on the line: orthopaedic trauma care in South Carolina.

There are approximately 300 orthopaedic surgeons in South Carolina, a state with a population of approximately four million. There is one orthopaedic surgeon per approximately 13,000 people, which should be adequate to meet the demand for orthopaedic care. The problem is not the quantity of orthopaedic surgeons. The problem is staffing our trauma centers with orthopaedic surgeons who are enthusiastic, have an interest in trauma care, and maintain high levels of CME and technical expertise. They need to be supported with appropriate medical liability reform, such as has been adopted in other states, and methods should be put into place to compensate surgeons for expensive, time consuming, and potentially risky procedures performed on uninsured and under insured patients. The number of patients with extremity trauma in South Carolina increased 25.6 percent during a five-year time period and is expected to continue to increase. It is estimated that 40 percent of all surgical charges generated for orthopaedic surgeons staffing trauma centers are for self-pay patients. Given the higher liability cost and lower reimbursement from other payer sources for elective procedures, it will soon become impossible for orthopaedic surgeons to continue to provide services at trauma centers without support from hospitals or government agencies.

Ambulatory Care↗
PubMed2003

The AANA Foundation Closed Malpractice Claims Study on nerve injuries during anesthesia care.

Anesthesia-associated nerve injury is a common cause of patient morbidity and litigation. To identify factors associated with perioperative nerve injuries and rationalize preventive strategies, 44 cases from the American Association of Nurse Anesthetists (AANA) Foundation Closed Malpractice Claims Database pertaining to nerve injuries in which nurse anesthetists provided care were analyzed. Emerging patterns and themes related to the development of injury were identified. The database is a collection of medical liability claims filed against CRNAs insured by the St Paul Fire and Marine Insurance Company; 44 claims of anesthesia-related nerve injury were analyzed. The most common injury was to the brachial plexus (15 [34%]), followed by ulnar nerve injury (7 [16%]), radial nerve injury (5 [11%]), peroneal nerve injury (4 [9%]), paraplegia (4 [9%]), lumbosacral injury (3[7%]), and a variety of "other" injuries (8[18%]). These numbers and percentages total more than 44 (100%) as some patients incurred multiple injuries. Documentation on the anesthesia record of the use of intraoperative protective padding and patient position was lacking or inadequate in a majority of the claims. Effective strategies for the prevention of nerve injury during anesthesia are reviewed. Abnormal body habitus, several disease states, anesthesia technique, improper positioning, lack of adequate padding, and tourniquet use have been implicated as risk factors.

Adolescent↗
PubMed2004

[Insurance for civil responsibility in professional medicine: insurance systems and coverage for posterity].

The author presents the systems of medical liability insurance available on the Belgian market; they are at the moment based on loss occurrence, claims made or fact occurrence. The systems based on loss occurrence and on claims made impose the provision of an additional premium. Problems connected with changing the insurance company are touched upon, including sometimes a necessity to provide a precedence premium.

Belgium↗
PubMed2004

Election 2004: implications for providers.

It may be difficult to believe, but President Bush and Senator Kerry do agree on a few important issues such as the need for improved healthcare information technology. But in regard to medical liability reform, health care for small businesses, and Medicare managed care, there are significant differences between their proposals. No matter who wins the presidential election, healthcare providers are going to feel the impact-especially with more seniors in HMOs and more low-income families seeking health care.

Health Care Reform↗
PubMed1979

[Panel discussion: problems of the specialist's duty to inform the patient (author's transl)].

The obligation of the physician to inform the patient--which he has to prove in case of a suit--is based on the patient's right of selfdetermination. This self-decision information was subject of the panel discussion. Not discussed in detail were the information concerning diagnosis and prognosis, and the instruction of the patient regarding his conduct postoperatively and during medical treatment. Not considered was the so-called malpractice and negligence respectively. Medical liability suits are increasing for various reasons and are frequently directed at a failure to inform the patient because the patient is often unable to prove a negligence of the physician ("surrogate liability"). The dimension of the duty of disclosure (complete information--no information at all) is discussed in general and with special regard to the radiological field.

Germany, West↗
PubMed2006

Serious complications after radiosynoviorthesis. Survey on frequency and treatment modalities.

AIM: Radiosynoviorthesis using intraarticular injection of beta-emitting radiocolloids is increasingly performed throughout Europe in patients with inflammatory joint disease. It is a cost-effective and safe treatment, local complications are very rare with only eight cases mentioned in the literature so far. No recommendations for therapy of tissue necrosis, infection or thromboembolism after radiosynoviorthesis are available. METHODS: Using a standardized questionary, 260 nuclear medicine physicians and 20 medical liability insurances were asked for the kind and frequency of complications after radiosynoviorthesis between 1998 and 2003. The survey was terminated after nine months with a response of only 25.7%. RESULTS: A total of 53 severe complications were documented (28 necroses, 12 thromboses, 13 joint infections). Eight other complications were seen but difficult to correlate directly with radiosynoviorthesis. Tissue necroses from yttrium-90 were successfully treated by surgical excision and closure of the defect. Rhenium-186-induced ulcers healed by hyperbaric oxygen therapy in two cases. Lesions from erbium-169 showed restoration by conservative treatment. Thromboembolic events happened after radiosynoviorthesis in joints of the lower limb only, mostly treated by conventional anticoagulation. Intraarticular infections showed restoration after intraarticular antibiotics in the majority of cases. CONCLUSION: Severe complications after radiosynoviorthesis seem to be rare. However, because of the low return rate, a reliable frequency cannot be calculated. Nevertheless, important advices regarding treatment concepts can be taken from our data.

Humans↗
PubMed1991

[Dental implantology and expertise. Apropos of 6 cases].

Dental implants are used with increasing interest each day. This costly material, which is reimbursed neither by Public Social Protection Agencies nor by private health insurance companies, has become a cause for lawsuits. We analyzed the experts' conclusions regarding legal mementos and expert reports, wherein medical liability (4 cases) and repair of dental injury (2 cases) were put into question. The experts stress the need to regard this technique as surgical, and to have it necessarily yield results. Repair of damage caused by dental trauma using implants does not alter conventional approaches in terms of social security cover for maintenance and replacement of dental prosthesis. Difficulties encountered by experts in evaluating injuries sustained by bone-adapted implants are evoked.

Dental Implantation, Endosseous↗
PubMed1988

Informed consent: considerations in aesthetic and reconstructive surgery of the breast.

A definite standard of care exists for establishing informed consent. The plastic surgeon has an obligation to meet these requirements with each patient undergoing surgery. The difficulties of adequately informing have been described and suggestions made for supplementing the consultation with a variety of adjuncts. The goal is to inform and use whatever methods are effective in achieving this goal. Establishing valid informed consent will not prevent all medical liability claims. Despite the most conscientious efforts to inform, some claims will still occur alleging "lack of informed consent." The surgeon must then prove that sufficient information was provided. However, many patients who feel that the surgeon made every effort to inform and felt that the surgeon was honest, conscientious, concerned, and thorough will be less inclined to generate claims even in the face of unsatisfactory results or untoward complications. Informed consent is the patient's right and the surgeon's obligation. The medicolegal benefits from fully informing are tangible and one of the most effective methods to reduce claims and modify risk.

Breast↗
PubMed1995

[Expert assessment within the scope of the sudden deafness disease picture].

Claims for medical liability mostly arise when a patient believes that his sudden deafness was not accurately diagnosed, diagnosed too late or insufficiently or was not well treated. Guided by seven expert opinions potential problems in indemnity were depicted. A clear misdiagnosis of sudden hearing loss (e.g., a hearing loss taken for eustachian tube disorder) will lead to an accusation of malpractice if the doctor cannot prove an accurate otological examination and appropriate diagnostic studies. The burden of proof lies with the doctor. A further consequence of a missed diagnosis is a delay in treatment. In the literature the good prognostic factor of early treatment has been stressed but without delineating a clearcut line between "in time" and "too late". An accusation of malpractice by insufficient treatment (pills instead of infusions) has risen. Since an unequivocal treatment is not established and various modalities of therapy are still controversial, disputes could be settled more easily. The validity of "no treatment" may be considered but requires accurate diagnosis and the patient must give informed consent. Such a procedure is justifiable, even from an ethical standpoint, when the patient fully understands and agrees.

Adult↗