SAN FRANCISCO, CA — More than half of malpractice claims for neurological problems involve preventable adverse events ranging from failure to communicate with other specialists to prescribing the wrong medication, a new study shows.
While the study did not pinpoint any one cause of preventable error, the findings point to the need for more open communication lines between the neurologist and everyone from residents to the patients' families, reported Thomas H. Glick, MD, Chief of Neurology at the Cambridge Health Alliance, Associate Professor of Neurology at Harvard Medical School in Boston, MA, and Vice Chair of the AAN Patient Safety Subcommittee.
“Patient safety – preventable adverse events – is an important issue that we as neurologists all have to get engaged in,” he told colleagues here at the 2004 AAN Annual Meeting. ''If you're trying to bat 1000 and see the patient cross the plate safely at home, follow-through is critical to success and safety in consultation. Size up the situation, articulate the diagnostic and therapeutic risks, assess the tempo of events, and consider alternative scenarios of how the problem may play out.
“Figure how to add value, not just round up the usual line-up of tests,” he continued. “And, even if you're not the pitcher, your role in teamwork and communication may be key to a win-win for patient and caregivers.”
Dr. Glick noted that national reporting of adverse events is not required, although the Institute of Medicine has mandated all disciplines “to see what can be done in our fields.”
To help focus neurologists' attention on patient safety, his team decided to turn to neurologic malpractice claims as a source of information, performing in-depth reviews of events – in which there was at least one neurologist defendant – that were filed with the Harvard Risk Management Foundation between 1986 and 1997.
“We tried to distinguish between patient safety and risk management, and focus on presenting adverse events that were important to patient care,” Dr. Glick said.
ANALYSIS OF DATA
For the study, the researchers initially reviewed 43 closed claims; from these, they judged 24 cases to involve credible – and preventable – patient harm. “The others ranged from the frivolous to non-preventable complications based on the patient's illness and were disqualified,” Dr. Glick explained.
The study found that the neurologist bore the primary responsibility in 13 of the 24 preventable cases. In all of the other 11 cases, in which the neurologist was named despite playing a subsidiary role or having minimal involvement, “the neurologist might have been able to play a bigger role in improving the outcomes or at least could have talked to the family to avoid a lawsuit,” Dr. Glick said. “The message: Once involved in a case, stay in the case.”
Dr. Glick said studies like this one can better characterize the reasons for adverse events and can help guide the decisions of neurologists in the future.
Nevertheless, there is still a long way to go to avoid preventable errors and improve patient safety, he said. Further studies are in the works and a patient safety section has been created on the AAN Web site (www.aan.com).
Also, “we're encouraging groups of neurologists to discuss their errors frankly within their practice group as a first step in changing the culture of secrecy and being more open,” he said.
MORE OPEN DIALOGUE NEEDED
Commenting on the issue, Glenn Graham, MD, PhD, Associate Professor of Neurology, Radiology, and Neurosciences at the University of New Mexico School of Medicine and Director of the Cerebrovascular Disorder Program at the VA Medical Center in Albuquerque, NM, agreed that more open dialogue between health care workers is needed.
“The current malpractice climate works against assuring patient safety, encouraging finger-pointing, secrecy, and cover-ups,” he told Neurology Today.
As a first step toward changing that climate, the Albuquerque VA Medical Center follows the process – called “root cause analysis” – mandated by the Joint Commission on Accreditation of Healthcare Organizations, when serious errors occur in hospitals, Dr. Graham said. “Whenever there is an adverse outcome that may or may not have been preventable, we gather groups of relevant experts, including neurologists, other physicians, nurses, and so on. Then we look at all the data and try to determine what, if anything, could have contributed to the adverse outcome and what, if anything, could have been done better.”
“It's a good tool,” Dr. Graham said. “We don't place blame; it's not driven by lawyers. But we get a chance to look at the underlying issues, to learn from them greatly. Unlike the malpractice system, which places blame and liability, this internal system allows us to correct a problem before more harm occurs.”
ARTICLE IN BRIEF
✓ A study of malpractice claims involving neurologists reported, among other findings, that neurologists bore the primary responsibility in 13 of 24 preventable medical errors.