Characterization of Medical Professional Liability Risks Associated With Transesophageal Echocardiography
| Autor: | William J. Oetgen, David M. Dudzinski, Sandeep S. Mangalmurti |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Clinical Decision-Making Perforation (oil well) 030204 cardiovascular system & hematology Risk Assessment 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Informed consent Physicians Humans Medicine Radiology Nuclear Medicine and imaging Intensive care medicine Aged business.industry Medical record Liability Reproducibility of Results Liability Legal Neck manipulation Guideline Middle Aged Medical decision making Insurance Liability medicine.disease Comorbidity Female Cardiology and Cardiovascular Medicine business human activities Echocardiography Transesophageal |
| Zdroj: | Journal of the American Society of Echocardiography. 32:359-364 |
| ISSN: | 0894-7317 |
| DOI: | 10.1016/j.echo.2018.11.003 |
| Popis: | Background Medical claim data offer the possibility to improve patient care and mitigate liability. Although published analyses exist in cardiology, no information is available for transesophageal echocardiography (TEE). In this study, the authors reviewed medical claims involving TEE to identify potential risk management concerns so that these lessons could be used to improve the safety and quality of transesophageal echocardiographic practice. Methods The authors reviewed anonymized clinical and claims data from all closed claims from 2008 to 2013 for a single national physician liability insurer. Results There were no claims involving transthoracic echocardiography and eight involving TEE. Three claims involved esophageal perforation, a known risk of TEE. Two claims involved quadriplegia allegedly due to neck manipulation in the setting of a cervical spinal abscess that should have been suspected. Three claims involved the cardiologist's failure to diagnose endocarditis, with allegations that the cardiologist did not perform TEE in an appropriate time frame to avoid major morbidity and mortality from endocarditis. Conclusions Liability claims associated with TEE involve failure to order and perform TEE in an appropriate clinical scenario and in a timely manner; failure to properly document medical decision making; failure to inform patients regarding risks of TEE; failure to properly monitor the patient before, during, and after TEE; and technical difficulties in performing the procedure. Cardiologists should recognize guideline-based indications when TEE is needed and be mindful of the complication rates of this procedure. When screening a patient for TEE, consider expert input that may reduce the risks of TEE (e.g., a spine specialist for a neck injury, a gastroenterologist for esophageal comorbidity). Informed consent and medical record documentation should be practiced as a vehicle to inform patients of these risks and chronicle decision-making processes. |
| Databáze: | OpenAIRE |
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