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Audit of litigation against the accident and emergency radiology department
- 作者:S. Cantoni (1)
F. De Stefano (2) A. Mari (3) F. Savaia (4) R. Rosso (4) L. Derchi (5)
- 关键词:Radiology ; Audit ; Civil liability ; Litigation ; Clinical risk management ; Radiologia ; Audit ; Responsabilità civile ; Contenzioso ; Management del rischio clinico
- 刊名:La radiologia medica
- 出版年:2009
- 出版时间:September 2009
- 年:2009
- 卷:114
- 期:6
- 页码:996-1008
- 全文大小:293KB
- 参考文献:1. Canadian Council on Health Services Accreditation (2002) Indicatori di Performance, Centro Scientifico Editore, Torino
2. Joint Commission on Accreditation of Healthcare Organizations (1998) Capire la prospettiva del paziente, Centro Scientifico Editore, Torino 3. Joint Commission on Accreditation of Healthcare Organizations (2003) Manuale, Libreria Bocca, Milano 4. Ministero della Salute, Dipartimento della Qualità, Commissione Tecnica sul Rischio clinico (2004) Risk Management in Sanità. Il problema degli errori, Ministero della Salute, Roma 5. Morosini P, Palombo G (2004) Variabilità nei Servizi Sanitari in Italia, Centro Scientifico Editore, Torino 6. Novaco F, Damen V (2004) La gestione del rischio clinico, Centro Scientifico Editore, Torino 7. Rasmussen J, Duncan K, Leplat J (1987) New technology and human error. Wiley, Chichester 8. Reason J (2000) Human error. Cambridge University Press, Cambridge 9. Fileni A, Magnavita N (2006) Dodici anni di osservazioni sul contenzioso assicurativo radiologico. Radiol Med 111:1009-022 lass="external" href="http://dx.doi.org/10.1007/s11547-006-0099-z">CrossRef 10. Thomas HG, Mason AC, Smith RM, Fergusson CM (1992) Value of radiograph audit in an accident service department. Injury 23:47-0 lass="external" href="http://dx.doi.org/10.1016/0020-1383(92)90126-D">CrossRef 11. Mann FA, Danz PL (1993) The night stalker effect: quality improvements with a dedicated night-call rotation. Invest Radiol 28:92-6 lass="external" href="http://dx.doi.org/10.1097/00004424-199301000-00032">CrossRef 12. Wardrope J, Chennells PM (1985) Should all casualty radiographs be reviewed? BMJ 290:1638-640 lass="external" href="http://dx.doi.org/10.1136/bmj.290.6482.1638">CrossRef 13. Brunswick JE, Ilkhanipour K, Seaberg DC, McGill L (1996) Radiographic interpretation in the emergency department. Am J Emerg Med 14:346-48 lass="external" href="http://dx.doi.org/10.1016/S0735-6757(96)90045-5">CrossRef 14. Wei C-J, Tsai W-C, Tiu C-M et al (2006) Systematic analysis of missed extremity fractures in emergency radiology. Acta Radiol 47:710-17 lass="external" href="http://dx.doi.org/10.1080/02841850600806340">CrossRef
- 作者单位:S. Cantoni (1)
F. De Stefano (2) A. Mari (3) F. Savaia (4) R. Rosso (4) L. Derchi (5)
1. U.O. Radiologia d’Emergenza, Azienda Ospedaliera Universitaria San Martino, Genova, Largo R. Benzi 10, Genova, Italy 2. Dipartimento di Medicina Legale, Università di Genova, Via De Toni 12, Genova, Italy 3. U.O. Affari Generali e Legali, Azienda Ospedaliera Universitaria San Martino, Genova, Largo R. Benzi 10, Genova, Italy 4. U.O. Ufficio Qualità, Accreditamento e Ufficio Relazioni Pubbliche, Azienda Ospedaliera Universitaria San Martino, Genova, Largo R. Benzi 10, Genova, Italy 5. DICMI -Radiologia, Università di Genova, Largo Rosanna Benzi 8, 16132, Genova, Italy
文摘
Purpose The aims of this study were to reduce and monitor litigation due to failure to diagnose a fracture, to evaluate whether the cases were due to radiological error or other problems in the diagnostic and therapeutic management of patients and to identify organisational, technical or functional changes or guidelines to improve the management of patients with suspected fracture and their expectations. Materials and methods We analysed the litigation database for the period 2004-006 and extracted all episodes indicating failure to diagnose a fracture at the accident and emergency radiology department of our centre. The radiographs underwent blinded review by two experts, and each case was jointly analysed by a radiologist and a forensic physician to see what led to the compensation claim. Results We identified 22 events (2004 seven cases; 2005 eight cases; 2006 seven cases). Six cases were unrelated to radiological error. Six were due to imperceptible fractures at the time of the examination. These were accounted for by the presence of a major lesion distracting the examiner’s attention from a less important associated lesion in one case, a false negative result in a patient examined on a incompletely radiolucent spinal board and underexposure of the coccyx region in an obese patient. Six cases were related to an interpretation error by the radiologist. In the remaining cases, the lesion being referred to in the compensation claim could either not be established or the case was closed by the insurance company without compensation. Corrective measures were adopted. These included planning the purchase of a higher performance device, drawing up a protocol for imaging patients on spinal boards, reminding radiologists of the need to carefully scrutinise the entire radiogram even after having identified a lesion, and producing an information sheet explaining to patients the possibility of false negative results in cases of imperceptible lesions and inviting them to return to the department if symptoms persist. Conclusions We believe the clinical and administrative analysis we performed is useful. It reviewed some administrative practices and identified critical features. We identified tools that we trust will reduce litigation.
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