ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Kashavarz   B. (*1)
Emsha Sahand   S. (1)
Eslaminia   E. (1)
Keshavarz   S. (2)






(*1) Isfahan Forensic Medicine Organization, Isfahan, Iran
(2) Clinical Psychology Department, Educational Sciences Faculty, Zanjan University of Medical Sciences, Zanjan, Iran

Correspondence

Address: Isfahan Forensic Medicine Organization, Feiz Square, Isfahan, Iran. Postal Code: 8165875735
Phone: +98 (31) 36619501
Fax: +98 (31) 6616310

Article History

Received:  January  30, 2019
Accepted:  April 29, 2019
ePublished:  June 20, 2019

BRIEF TEXT


Today with increasing the number of surgeries and their variety, malpractice complaints against anesthesia care team are increased.

... [1]. Many studies have been conducted on mortality due to anesthesia and it should be noted that most of these studies have referred to the influence of several simultaneous factors, especially personnel errors, as an important factor in these deaths [2]. International reports of medical complaints also show that complaints have been on the rise. In addition, today medical errors are one of the main problems in public health, as many of these errors cause harm to health needs and costs [3]. … [4].

The aim of this study was to recognize the causes and effective factors in injuries lead to the anesthesia malpractice.

This was a cross-sectional descriptive-analytical study.

This study was carried out on the files of malpractice complains against the anesthesia care team in the Isfahan Legal Medical Organization in 2009-2015.

For this purpose, the available information was extracted from patients' complaints and clinical records sent from the hospital were recorded in a researcher-made questionnaire. Therefore, all anesthesia malpractice cases (60 cases) were evaluated by simple census. Data collected included age of physician, physician history, anesthesia method, cause of complaint, type and degree of anesthesia malpractice and view of Legal Medical Organization experts.

The field data collection method was used by reviewing medical anesthesia malpractice records of staff presented to Isfahan Legal Medical Organization. Finally, the data were analyzed using descriptive statistics by SPSS 23 software.

Of all 1,071 cases, in which care team was complained between 2009 and 2015, sixty cases (5.6% of total cases) were related to complaints from anesthesia team, of which 34 cases were men (56.7%) and 26 were women (43.3%). In 28 cases (46.7%), anesthesia malpractice was identified and in 32 cases (53.3%) anesthesia malpractice was not verified and the anesthesia team acquitted. In 28 cases of anesthesia tem malpractice, the anesthesiologist was also found guilty. Of 28 cases with anesthesia malpractice, the most frequent malpractice type was imprudence. Of all surgeries, 53.3% cases were performed in the morning shift, 33.3% in the evening and 13.3% in the night shift. Among the verified anesthesia team malpractice, 15 operations (53.6%) were performed in the morning shift, 9 operations (32.1%) in the evening shift, and 4 operations (14.3%) in the evening shift. Regarding the age of the physicians for whom anesthesia malpractice was verified, the highest age range was 40-50 years (46.4%) followed by 50-60 years (25.0%), 40-35 years (21.4%) and over 60 years (7.1%). In terms of physicians' work experience, the most common malpractice was in physicians (13 cases (46.4%)) with 10-20 years of experience, followed by 8 cases (28.6%) with 20-30 years of experience, 5 cases (17.9%) with over 5-10 years and 2 physicians (7.1%) with over 30 years of work experience. Of the patients who had been harmed by anesthesia malpractice, 6 cases (21.4%) were younger than 19 years (children), 3 cases younger than 6 months and 3 patients were younger than 10 years old. In addition, 11 subjects (39.2%) were between 20-35 years old (young), 6 subjects (21.4%) between 35 and 65 years (middle age) and 5 subjects (17.9%) were over 65 years old. In terms of time, 17 cases (60.7%) were occurred during surgery, 6 cases (21.4%) post-operation surgery, 4 cases (14.2%) during transfer to the ward and in one case (3.6%) in recovery. The level of education of the anesthetist was anesthesiologist in 58 cases (96.7%) and resident anesthesiologist in 2 cases (3.3%). In all anesthesia malpractice cases, 73.3% underwent general anesthesia and 26.7% underwent local anesthesia. Of the 28 cases of anesthesia malpractice, 22 cases (78.6%) had general anesthesia and 6 cases (21.4%) had local anesthesia. Of the 28 cases of anesthesia malpractice, in 22 cases (78.6%) errors in patient monitoring and in 6 cases (21.4%) no errors in patient monitoring were recorded. Of the 28 cases of anesthesia malpractice, one case (3.6%) was due to an anesthetic dose error. In 7 (25.0%) out of the 28 cases of anesthesia malpractice, it was related to anesthesia equipment and in addition to the anesthesiologist, the hospital technical officer was also blamed. In 3 (10.7%) out of 28 cases, anesthesia malpractice was due to the wrong drug injection. In 6 cases (21.4%) out of all cases, clinical and paraclinical tests were not required by the anesthesiologist before surgery and in 22 cases (78.6%), preoperative clinical and paraclinical tests were requested by an anesthesiologist. Preoperative consultations were not performed by anesthesiologists in 12 patients (42.8%) and in 16 patients (57.1%) were considered. The highest number of anesthesia malpractice cases were occurred in the private hospitals 15 (53.6%), followed by the public hospitals 9 (32.1%) and the lowest number of cases were recorded in the teaching hospitals (4 (14.3%)). Of the total 60 anesthesia malpractice cases, 38 cases (63.3%) were due to patient death. Of the 28 recorded cases, 17 cases (60.7%) resulted in death due to the anesthesiologist malpractice, in 10 patients (35.7%) resulted in impairments and in one case (3.6%) no complications were reported. Of the 38 deaths reported in these cases, 29 cases (76.2%) were biopsied and autopsied, and 9 cases (23.8%) were not biopsied and the body was buried without autopsy. The organs involved which resulted in adverse effects were respiratory tract in 29 patients (48.3%) and cardiovascular system in 24 patients (40.0%), respectively. The further complications were stroke, shock, water and electrolyte disturbances, skin necrosis, and drug allergies.

In the present study, 46.7% of the anesthesia care team was found guilty and sentenced to pay and in all cases, the anesthesiologist was also blamed. However, in the Bastani et al. study [37], 37.1% of anesthesiologist's malpractice were confirmed and also in the study by Mahfouzi et al. [66] in Tehran, in 66.2% of the cases, anesthesiologist's was found guilty. The highest number of malpractice cases was occurred in the private hospitals (53.6%) and the lowest in the teaching hospitals (14.3%). In a study conducted in Shiraz Legal Medical Organization [5], the least malpractice rate was observed in educational hospitals and the highest in private hospitals. … [7-11].

Prospective studies on high-risk cases in the anesthesia area are recommended.

One of the limitations of this study was the lack of sufficient information about the details of the clinical records of all cases of malpractice and also no complaint in all cases of anesthesia malpractice.

Depending on the specific conditions in the operating rooms, visits of patients by anesthesiologist before surgery, performing required tests and advice, perception in determining the anesthesia method especially in elective surgery, pay attention to the patient's respiratory system function during surgery, anesthesia and in recovery status is very necessary to reduce the anesthesia errors. As well as it is necessary to have an autopsy of the corpse in the case of a patient's death or impairment in order to identify the culprit easily.

We would like to thank the Iran Legal Medicine Organization Research Center and the Director of Legal Medicine in Isfahan who helped us in this project.

None declared.

This study was approved by the Isfahan Research Council and the Iran Legal Medicine Organization Research Center.

This study was funded by the grant from the Legal Medical Organization Research Center.


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