Using medico-legal claims for quality improvement in maternity care: application and revision of an NHSLA coding taxonomy.
Epidemiology: general obstetric
health services research
medical law
risk management
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
accepted:
29
06
2019
pubmed:
28
5
2019
medline:
17
10
2019
entrez:
28
5
2019
Statut:
ppublish
Résumé
To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement. Qualitative descriptive study. Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia. All obstetric claims and incident notifications occurring within the date range were included for analysis. De-identified claims and notifications data were derived from the files of the insurer of Victorian public health services. Data included claim date, incident date and summary, and claim cost. All reported issues were coded using the NHSLA taxonomy and the lead issue identified. Rate of claims and notifications, relative frequency of issues, a revised taxonomy. A combined total of 265 claims and incidents were reported during the 6 years. Of these 59 were excluded, leaving 198 medico-legal events for analysis (1.66 events/1000 births). The costs for all claims was $46.7 million. The most common claim issues were related to management of labour (n = 63, $17.7 million), cardiotocographic interpretation (n = 43, $24.4 million), and stillbirth (n = 35, $656,750). The original NHSLA classification was not sufficiently detailed to inform care improvement programmes. A revised taxonomy and coding flowchart is presented. Systematic analysis of obstetric medico-legal claims data can potentially be used to inform quality and safety improvement. New taxonomy to target health improvement from maternity claims based on NHSLA Ten Years of Maternity Claims.
Identifiants
pubmed: 31131503
doi: 10.1111/1471-0528.15823
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1437-1444Subventions
Organisme : National Health and Medical Research Council
ID : APP1113902
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 Royal College of Obstetricians and Gynaecologists.
Références
Järvelin J, Häkkinen U. Can patient injury claims be utilised as a quality indicator? Health Policy 2012;104:155-62.
Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, vol. 2013. London: The Stationary Office, 2013.
Duckett S, Cuddihy M, Newnham H. Targeting zero. Supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care. Report of the Review of Hospital Safety and Quality Assurance in Victoria. Melbourne: DHHS, 2016.
Nowotny BM, Loh E, Lorenz K, Wallace EM. Sharing the pain: lessons from missed opportunities for healthcare improvement from patient complaints and litigation in the Australian health system. Aust Health Rev 2018. https://doi.org/10.1071/AH17266
Nowotny BM, Loh E, Davies-Tuck M, Hodges R, Wallace EM. Using patient factors to predict obstetric complaints and litigation: a mixed methods approach to quality improvement. J Patient Saf Risk Manag 2018;23:185-99.
Ford KE, Cooper LRL. Learning from lawsuits: ten-years of NHS litigation authority claims against 11 surgical specialities in England. Surgeon 2018;16:27-35.
Dickson N, Kayll S, Kenny C, MacEwen C, Nagpaul C, Swinyard P, et al. NHS confederation letter to the Rt Hon David Gauke MP regarding reforms to handling of clinical negligence claims 2018. London: NHS Confederation, 2018
Her Majesty's Treasury. Public Expenditure Statistical Analyses. London: HM Treasury, 2006.
National Audit Office. Managing the Costs of Clinical Negligence in Trusts. London: NAO, 2017.
Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff 2010;29:1569-77.
Australian Institute of Health and Welfare (AIHW). Australia's Medical Indemnity Claims. Melbourne: AIHW, 2012.
Dickson K, Hinds K, Burchett H, Brunton G, Stansfield C, Thomas J. No-Fault Compensation Schemes: A Rapid Realist Review to Develop a Context, Mechanism, Outcomes Framework. London: Department of Health, 2016.
Sladden N, Graydon S. Liability for medical malpractice-recent New Zealand developments. Med Law 2009;28:301-15.
Oliphant K. Beyond misadventure: compensation for medical injuries in New Zealand. Med Law Rev 2007;15:357-91.
Shah A, Kemp B, Sellers S, Hinton L, O'connor M, Brocklehurst P, et al. Towards optimising local reviews of severe incidents in maternity care: messages from a comparison of local and external reviews. BMJ Qual Saf 2017;26:271-8.
Hibbert PD, Thomas MJW, Deakin A, Runciman WB, Braithwaite J, Lomax S, et al. Are root cause analyses recommendations effective and sustainable? An observational study. Int J Qual Health Care 2018;30:124-31.
Reader TW, Gillespie A, Roberts J. Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;23:678-89.
Gillespie A, Reader TW. Patient-centered insights: using health care complaints to reveal hot spots and blind spots in quality and safety. Milbank Q 2018;96:530-67.
Anderson A. Ten years of maternity claims: an analysis of the NHS Litigation Authority data-key findings. Clin Risk 2013;19:24-31.
NHS Litigation Authority. Ten Years of Maternity Claims. London: NHSLA, 2012.
Zhang Y, Wildemuth B. Qualitative analysis of content. In: Wildemuth B, ed. Applications of Social Research Methods to Questions in Information and Library Science. Santa Barbara, CA: Libraries Unlimited, 2009, p. 421.
Harrison R, Walton M, Healy J, Smith-Merry J, Hobbs C. Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints. Int J Qual Health Care 2016;28:240-5.
Draper ES, Gallimore ID, Kurinczuk JJ, Smith PW, Boby T, Smith LK, et al. MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2016. Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester, 2018.
Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, et al., eds. Saving Lives, Improving Mothers’ Care-Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2018.
Royal College of Obstetricians and Gynaecologists (RCOG). Each Baby Counts: 2015 Full Report. London: RCOG, 2017.
National Health and Medical Research Council (NHMRC). National Statement on Ethical Conduct in Human Research. Canberra: NHMRC, 2007.
B-Lynch C, Coker A, Dua JA. A clinical analysis of 500 medico-legal claims evaluating the causes and assessing the potential benefit of alternative dispute resolution. BJOG 1996;103:1236-42.
Nelson KB, Grether JK. Causes of cerebral palsy. Curr Opin Pediatr 1999;11:487-91.
Jonsson M, Lindeberg Nordén S, Hanson U. Analysis of malpractice claims with a focus on oxytocin use in labour. Acta Obstet Gynecol Scand 2007;86:315-9.
Navathe SB, Kerschberg L. Role of data dictionaries in information resource management. Inf Manag 1986;10:21-46.
De Lusignan S, Liaw ST, Michalakidis G, Jones S. Defining datasets and creating data dictionaries for quality improvement and research in chronic disease using routinely collected data: an ontology-driven approach. Inform Prim Care 2012;19:127-34.
De Lusignan S. Codes, classifications, terminologies and nomenclatures: definition, development and application in practice. Inform Prim Care 2005;13:65-9.
Pettker CM, Thung SF, Lipkind HS, Illuzzi JL, Buhimschi CS, Raab CA, et al. A comprehensive obstetric patient safety program reduces liability claims and payments. Am J Obstet Gynecol 2014;211:319-25.
Jorm C, Hudson R, Wallace EM. Turning attention to clinician engagement in Victoria. Aust Health Rev 2019;43:123-5.