Claims allege failure to monitor surgical patients
EXECUTIVE SUMMARY
Common allegations in malpractice claims involving surgical patients are failure to obtain a proper medical history, failure to perform a preoperative examination, and failure to monitor patients postoperatively.
• Conduct preoperative briefings.
• Provide recovery teams with readily available contact information for the surgeons and back-up contacts.
A recent malpractice case named an orthopedic surgeon who had prophylactically placed a patient on antibiotics days before performing arthroscopic surgery to clean up scar tissue on the patient’s ankle.
"The surgeon failed to appreciate that the patient had developed the early stages of Stevens-Johnson syndrome," says Nan Gallagher-Auferio, JD, Esq., an attorney at Kern Augustine Conroy & Schoppmann in Bridgewater, NJ.
The plaintiff alleged that if a proper medical history been obtained and a thorough preoperative examination been performed, the surgery would have been aborted and the patient would have been sent to the hospital for immediate interventions to be performed. "Here, the surgeon putting the patient under general anesthesia only intensified the adverse reaction of the syndrome, and the patient went into multi-organ failure in the lobby of the surgery center. She subsequently died," says Gallagher-Auferio. The case was settled for $550,000.
In another case involving failure to monitor a patient, an anesthesiologist was sued after a patient developed disseminated intravascular coagulopathy in the post-anesthesia care unit (PACU) following removal of a malignant testicle at an outpatient surgery center. The surgeon left the building.
"The anesthesiologist left the building without properly monitoring the patient’s postoperative vital signs and failed to respond to multiple pages from the PACU nurses," says Gallagher-Auferio. "The patient later died. The physician’s conduct was indefensible."
Claims stem from communication lapses
Communication lapses are a frequently cited cause of medical malpractice cases, according to Cindy Wallace, CPHRM, senior risk management analyst at ECRI Institute, a Plymouth Meeting, PA-based organization that researches approaches to improving the safety, quality, and cost-effectiveness of patient care.
To protect themselves against these claims, Wallace recommends these practices:
• The surgical team should conduct a preoperative briefing to share information on the patient.
For example, the physician/surgeon and anesthesia provider should review the pre-anesthesia evaluation of the patient to discuss any known risks and the plan to minimize these risks.
• The physician/surgeon should ensure that the recovery team knows how to reach him or her, as well as a back-up contact, in case any questions or concerns arise.
• There should be an established process for handing off the patient from the surgical team to the recovery team.
"Standardized communication tools, such as the SBAR [Situation-Background-Assessment-Recommendation] briefing tool, should be used to clearly describe the patient’s condition and key concerns and recommendations for the patient’s recovery," says Wallace.
