2-3 page apa format Case study

timer Asked: Nov 19th, 2016

Question description



1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words.

2. Your Critique (50%)

Case Study:

Surgical mistakes can result in serious medical complications for patients. Errors by surgeons can run the gamut from performing unnecessary surgery on a patient, to negligent technique in carrying out the procedure -- even leaving medical instruments inside a patient. Many (though not all) common surgical mistakes rise to the level of medical negligence and can form the basis of a medical malpractice lawsuit against the surgeon and any other responsible party. To give you an idea of what these cases might look like, this article provides a snapshot of three real-life surgical mistake medical malpractice cases.

Sophia Savage Case

In 2001, Sophia Savage underwent a hysterectomy at the Three Rivers Medical Center in Louisa, Kentucky. During the surgery, a surgical sponge was left inside her abdomen, but the presence of the sponge wasn't revealed until 2005, when Savage had an x-ray after she reported pain in her stomach. She had to undergo additional surgery to remove the sponge. During this procedure it was discovered that the sponge was lodged in her lower intestine. The doctors had to remove a 49 centimeter section of her small intestine in order to remove the sponge. Due to this she suffered from lingering abdominal pain, diarrhea, and constipation as well as bouts of anxiety and depression. She and her husband Darrell file a surgical mistake lawsuit against the Three Rivers Medical Center. The court awarded them $2.5 million in damages. Her husband Darrell was awarded additional $500,000 for loss of consortium.

  • Discussion, designate and remark the Risk Management strategies and recommendations to prevent this Medical Malpractice Situation happen again.

3. Conclusion (15%)

Briefly summarize your thoughts & conclusion to your critique for the case study.How did these articles and Chapters impact your thoughts on Inform Consent and Patient Education?

Evaluation will be based on how clearly you respond to the above, in particular:

a) The clarity with which you critique the articles;

b) The depth, scope, and organization of your paper; and,

c) Your conclusions, including a description of the impact of these articles and Chapters on any Healthcare Organization.

Chapter 8: Patient Safety Tools: Integrating Quality and Managing Risk Why do we talk about Quality in the Risk Management setting? • Risk management makes contributions to quality by assuring that hazards and injuries are less likely to occur for both patients and employees. • Risk management works to prevent malpractice claims by identifying, analyzing and treating risks which quality assessment tries to eliminate Predicting Hazards and Malpractice • Prediction is not specific in risk management – can say an event is likely to occur, but not when or to what extent • Confounding factor: increased patient satisfaction tends to correlate to lower likelihood of legal action by a patient • Incident Reporting: can assist the risk manager in identifying causes Healthcare Acquired Conditions • Conditions for which, when acquired during admission in the health facility, CMS will not reimburse. • Examples include: – Foreign object retained after surgery – Air embolism – Blood incompatibility – Pressure ulcer stage III and IV – Falls and trauma – Catheter-associated infection – Manifestations of poor glycemic control Importance of Communication • Effective communication is a factor in the likelihood of a patient deciding not to sue a provider as it has impact on patient satisfaction • Informed Consent is the result of effective communication between the provider and patient. The patient needs to know the possible outcomes of treatment, both good and bad, so as to have proper understanding and expectations. What if Unanticipated Outcomes Occur? • Disclosure of unanticipated outcomes is mandatory. The ethical question is NOT should it be disclosed, but how and by whom. • Risk managers need to plan, prepare and educate staff to avoid inappropriate disclosure Enterprise Risk Management (ERM) • An approach to assessing and addressing risks from all sources that either threaten the organization’s objectives or represent opportunities to exploit competitive advantage. • Categories of Risk – – – – – – – Operational/Clinical Risks Financial Risks Human Capital Risks Strategic Risks Legal/regulatory Risks Technological Risks Natural Disaster/Hazard Risks Difference from Traditional Risk Management • Traditional Risk Management took a more clinically focused approach and examined risks individually. • With ERM, the Risk Manager has a larger focus and more strategic position. It begins with risk identification and determination of the relative importance of the risk ERM Process • ERM utilizes the steps in the traditional risk management process – Identify and analyze the exposures to loss – Examine the feasibility of alternative techniques – Select the best technique – Implement the technique – Monitor and improve the risk management program Quality and Risk Management • Historically Risk Management and Quality initiatives were seen as separate. • Today, organizations utilize a more integrated approach, recognizing that many risk management errors are breakdowns in process (quality) rather than individual error. Quality Management Techniques • Quality Assurance – a formal, systematic program by which care given to patients is measured against established criteria. • Quality Management – encompasses monitoring and evaluating quality issues, followed by changes in the system. Quality Management Techniques Total Quality Management – W. E. Deming • TQM focuses on the system not the individual – 85/15 rule – 85% of problem is related to system failure and 15% is the fault of the people involved • Three premises: – Quality is important and can be measured – People are part of the solution not the problem – Change is fundamental and can be managed Quality Management Techniques • Continuous Quality Improvement (CQI) – process used to improve their ability to satisfy customer expectations. – Directs attention to the fundamental mechanism that drives a process or system. – Focuses on techniques to accomplish positive change by assessing a process that leads to an intervention. – Use of sentinel events 4 Stages for Process Improvement • Dr. Steven Speer recommends the following states to assist with process improvement: – System design and operation – Problem solving and improvement – Knowledge sharing – Developing high velocity skills in others Other Quality Tools from Industry • Lean Management focuses on reducing waste and eliminating error in processes. • Six Sigma focuses on eliminating causes of defects or error and minimizing variability in process. Barriers to Quality Management Initiatives • Separation of administrative functions – CQI implementation can be difficult as physicians tend to focus on patients not administrative responsibilities • Hierarchical and bureaucratic structure makes empowerment difficult • Lack of recognition of problem-solving initiative • Lack of vision of the desired outcome • Inflexible attitude of “this is how it’s always been done” Quality Improvement Teams • Quality Improvement Teams (QIT) are change agents. • Can investigate and recommend improvements, many times in conjunction with the risk manager who may or may not be a member of the team. Customer is Key • The quality improvement process views the customer as central to its purpose. • It is imperative to know who the customer is and their importance to providing care. – Note: the customer is not always the patient. CQI and Labor Relations • Risk managers should make sure that any QIT or other CQI program teams are reviewed and deemed allowable by the NLRA. – Some teams may be viewed as labor organizations dominated by the employer if not structured properly Determining the Effectiveness of Risk Management • There is currently no research to definitively demonstrate the effectiveness of risk management programs. • However, risk management programs are important as adverse events do happen, and there is a need to investigate and implement strategies/improvements to minimize the risk of adverse events recurring. Program Evaluation • What are the areas of responsibility or functions defined for risk management? • Which information or data are collected and available within each of these areas of responsibility or function? • Can this information or data be categorized and analyzed systematically to derive measures of effectiveness? Use of Standards • A standard must be reasonable, achievable and measurable • Results standards: what is accomplished • Activity standards: means by which something is accomplished Evaluation Tools • Root Cause Analysis • Failure Mode, Effect and Criticality Analysis External Evaluation • The Joint Commission may evaluate a healthcare organization’s risk management program during the accreditation process. • Third party payers may also evaluate risk management programs to determine insurability of the organization. • Benchmarking with other organizations. Practice Guidelines • Practice guidelines can set a standard of care to help minimize risk • May be difficult to monitor • Risk increases as departure from stated guidelines can be a source of liability High Exposure Issues • • • • • • • • Clinical Activities Monitoring Medical Records Electronic Health Records HIPAA Credentialing Withholding of Treatment Disclosure Summary • Quality and Risk Management overlap • Risk Managers can utilize quality techniques and reports to assess risk and recommend improvements
Chapter 9: A Primer on Medical Malpractice Malpractice – What is it? • Error - behavioral matter • Misperception • Mistake • Omission • Substitution • Accident - unplanned event • Malpractice - negligence Negligence • An act that a prudent person would not have done or the omission of a duty that a prudent person would have fulfilled, resulting in injury or harm to another person. – A civil wrong and part of the law of torts. – Founded on the relationship between the actor and the victim Requirements of an Act of Negligence • Legally recognized relationship between the health care worker and patient • Health care worker has a duty of care to the patient • Health care worker breached the duty of care by failing to conform to the required standards of care • The breach of duty was the direct cause of harm, resulting in the patient suffering damages as a result of the harm Malpractice • Negligence that is the proximate cause of injury or harm to a patient resulting from – A lack of professional knowledge, experience or skill that can be expected in others in the profession. OR – From failure to exercise reasonable care or judgment in the application of professional knowledge, experience or skill. Medical Malpractice • The commission or omission of an action causing an injury is shown to arise from the exercise of professional medical judgment • There must be: – A Physician-Patient Relationship – A Duty to Perform Professionally Sources of Professional Standards • Government statutes and regulations • Professional society standards • Voluntary accrediting agency standards • Administrative policies and rule of the facility Theories of Liability • Informed consent • Strict liability • Vicarious liability • Res ipsa loquitur Re ipsa loquitur The thing speaks for itself – Injury would not ordinarily occur in the absence of negligence – Injury was caused by the actions was within the control of the defendant – Injury is not due to any action on the part of the plaintiff – Evidence surrounding the circumstances is mostly within the control of the defendant Hospital Liability for Malpractice • Respondeat superior • Ostensible agency • Staff Privileges – Corporate Negligence – Contributory Negligence Other Liability Theories • Intentional tort • Assault and battery • Libel • Slander • Invasion of Privacy Types of Damages • Compensatory damage • Awards for pain and suffering • Punitive damages Statute of Limitations • The maximum period of time after the patient’s injury during which a lawsuit may be commenced. • Most state have a statutory period between one and three years. • Typically the statutory period is deferred (tolled) during infancy and starts to run only on the patient’s 18th birthday. Common Malpractice Allegations • Surgery/post-op complications • Failure to diagnose cancer • Surgery/inadvertent act • Improper treatment (birth related) • Failure to diagnose fracture or dislocation Most Expensive Settlements • Improper treatment (birth related) • Failure to diagnose hemorrhage • Failure to diagnose myocardial infarction • Failure to diagnose infection • Failure to diagnose cancer Other concerns which may impact liability • Unrealistic patient expectations • Non response to complaints • Illegible medical records • Insufficient information in medical records • No follow-up on abnormal tests • Professional miscommunication Summary • Risk Managers need to be aware of both professional and facility liabilities • Malpractice claims can be very complex • Setting policies and procedures and following them are important in minimizing malpractice liability

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