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Data helps states make improvements to patient safety
by LOUISE ESOLA
Published March 26, 2007
CHICAGOSeveral changes made in the medical arena since the Institute of Medicine's groundbreaking 1999 report on medical errors are helping to prevent costly hospital mistakes, but the work must continue, experts say.
One particular change that is garnering attention is the practice of documenting "near misses," or incidents in which a mistake could have occurred but did not as a result of efforts to avoid the potential error, they said.
The topic was discussed during a session at the Professional Liability Underwriting Society's annual Medical Professional Liability Symposium in Chicago by a panel of hospital risk managers, an insurance underwriter and a consultant who examined the state of patient safety in medical practice today.
The Institute of Medicine's 1999 study, "To Err is Human: Building a Safer Health System," highlighted a then-startling statistic: 98,000 people die each year from medical errors, causing more deaths than car accidents, breast cancer or AIDS. The report documented mistakes such as medication overdoses, drug mix-ups and even one patient's case in which the wrong leg was amputated.
That 312-page report, said Ronni Soloman, executive vp and general counsel for the Emergency Care Research Institute in Plymouth Meeting, Pa., served as a catalyst for changes in the medical arena that are ongoing. As a result, she said, instances of medical errors have declined.
Currently, more than 20 U.S. states have medical safety reporting systems to document mistakes made at hospitals and clinics.
Pennsylvania, for example, has a system that documents up to 16,000 mistakes and near misses per month, Ms. Soloman said, with most incidents being near misses. Pennsylvania, she said, is the only state that requires hospitals to record potential errorsinformation that becomes invaluable when trying to enhance patient safety.
For example, one report filed by a nurse noted that packages for different sizes of syringes looked nearly identical, which could cause a practitioner or nurse to give someone a tenfold overdose of insulin. In another instance, one report found that color-coded wrist bands given to patients to alert medical staff of an anomaly, allergy or special need meant different things at different hospitals. For example, a blue wristband alerts medical staff at one hospital that a patient has a pacemaker; at another hospital, the blue wristband on the patient denotes "allergic to latex."
While states are on the forefront of documenting medical confusion and errors, hospitals also are taking steps to prevent mistakes.
Alexian Bros. Hospital Network in Arlington Heights, Ill., is one medical system that has created a focus on patient safety. More information is being shared among workers at the system's eight facilities northwest of Chicago and more attention is being paid to practices or issues that could lead to major errors, said Diana Woytko, vp of patient safety and quality.
The system has a number of committees that meet several times a month to go over reports that document mistakes and near misses. Ms. Woytko said the data on near misses has played a large role in enhancing patient safety.
"We can react to instances as they occur but patient safety is much more than that," she said. "Here, we're saying let's fix it before it actually happens."
Early intervention, answering questions build on tort reform
by LOUISE ESOLA
Published March 26, 2007
CHICAGOMany in the medical arena look to tort reform as a shelter from the increasing severity of medical malpractice lawsuits, but experts in the field say there are other ways to cap potentially enormous awards.
Early investigation of and intervention in cases and a step as simple as apologizing are among tried-and-true tactics that could turn a giant lawsuit into a smaller case, according to a panel of experts and attorneys at the Professional Liability Underwriting Societys annual Medical Professional Liability Symposium that was held earlier this month in Chicago.
Tort reform is only part of the solution, said John OByrne, an equity partner at Mendes & Mount L.L.P. in New York, who led the panels discussion about ways to quell the severity of malpractice lawsuits.
Panel members said while frequency of malpractice suits is down, severity continues to rise. Severity is what continues to drive the medical malpractice crisis, Mr. OByrne said. Tort reform is making major headway in Texasone of a number of so-called judicial hellholesand is on the agenda for lawmakers in other states, but it will take years to be implemented fully, he and others said.
In the meantime, there are steps hospitals and doctors can take to avoid massive claims. In addition, the health care providers and professionals as well as their insurers need to pay special attention to time, experts said.
Tim Smith, vp for of the claims department for the Insurance Physicians Co. in Denver, said one best practice is to aggressively evaluate and address cases as early as possible, with the goal of entirely avoiding a lawsuit or coming to an early resolution of a dispute.
These (cases) dont age too well, he said. At 18 months, these things tend to go north (in costs.)
Often, Mr. Smith said, suits are filed when patients do not get answers to their questions from the hospital or their doctor.
You have to aggressively work to get patients what they need to resolve the anxiety and trauma to the family, he said. If you can work to dissuade someone from processing a minor claim, you are going to save some money.
Steve W. Day, an attorney and shareholder with Marshall, Dennehey, Warner, Coleman & Goggin in King of Prussia, Pa., said there is a major advantage in addressing claims and suits early on. Many hospitals and doctors offices have high turnover rates, meaning workers who may have been present during a mishap may no longer be working there when the case is heard in court, he said. Nursing homes, often ground zero for lawsuits, tend to see files vanish quickly, he added.
(Addressing the claim early) helps identify cases that need to be resolved early on, Mr. Day said.
Im Sorry laws
Another tactic that is helping keep claims from becoming severe are the new Im Sorry or apology laws now present in a number of states, and the overall understanding that medical malpractice claims wouldnt be as great if defendants admitted fault, or apologized for an adverse reaction to a procedure, and helped patients achieve resolution.
The apology laws vary from state to state, but basically give doctors and hospitals the opportunity to apologize to their patients without that apology being allowed in court as an admission of liability. The reforms, experts say, have helped keep a wave of cases out of the courts.
Karl Bayer, an attorney, arbitrator and mediator in Austin, Texas, who has represented plaintiffs in medical malpractice lawsuits, called the Im Sorry tactics brilliant.
Why did people come into the plaintiff attorneys door? They want to know what happened, Mr. Bayer said during the panel discussion. Ive seen many, many things that could have been done early on (to avoid massive lawsuits).
by LOUISE ESOLA
Published March 26, 2007
CHICAGOAbout 550 medical malpractice underwriters, brokers and risk managers attended the Professional Liability Underwriting Society's seventh annual Medical Professional Liability Symposium held March 13-14 in Chicago.
The two-day symposium featured presentations and discussions that included nearly three dozen experts in the fields of medical malpractice and the future of health care liability.
A variety of topics were covered, including a surge in the number of health care captives, the role and liabilities associated with technology in the medical arena, and upcoming improvements to medical risk management.
Information about next year's symposium will be available later this year at the society's Web site located at www.plusweb.org.