Medical Malpractice Insurer: Inadequate Pre-Op Assessments Create Risks for Anesthesiologists

When reviewers identified inadequate histories and physicals, 67% of those patients were found to have at least one comorbidity—such as obstructive sleep apnea.

A new study by The Doctors Company shows that inadequate pre-operation patient assessments are a major factor in medical malpractice suits against anesthesiologists.

The study, by the nation’s largest physician-owned medical malpractice insurer, analyzes new trends in claims involving anesthesia care, includes a case study of a patient with multiple comorbidities, and provides risk mitigation strategies.

In their analysis of closed malpractice cases against anesthesiologists, physician reviewers found that the top three factors leading to patient injury were:

  • Deficiencies in patient assessments, including history and physicals.
  • Patient monitoring.
  • Communication among providers.

When physician reviewers identified inadequate histories and physicals, 67% of those patients were found to have at least one comorbidity—such as obesity and obstructive sleep apnea.

“This study reveals limited opportunities to conduct pre-op assessments, which could identify comorbidities and issues with the patient’s family medical history in advance of surgery,” says Darrell Ranum, JD, CPHRM, study co-author and vice president of patient safety and risk management with The Doctors Company, in a release. “Production pressures often limit testing and input from anesthesiologists and their ability to arrange for the safest location for care or prepare for complications that might occur.

“As part of our mission to advance the practice of good medicine, we encourage surgeons, proceduralists, and healthcare organizations to work together to complete adequate assessments and testing prior to surgery.”

Susan K. Palmer, MD, board certified anesthesiologist and co-author of the study, agrees. “Particularly in a private setting, anesthesiologists may feel pressure to perform a cursory review of the patient and the patient’s history,” Palmer says. “Even when anesthesiologists are provided the opportunity for an adequate pre-op assessment and find something of concern, they may feel pressure not to postpone the surgery or not to move the patient to a hospital setting.”

To avoid these risks, Palmer recommended the following: That patients ask for a consultation with their anesthesiologist a week before surgery; healthcare organizations send pre-anesthesia questionnaires to patients; and anesthesiologists and surgeons reach a compromise solution when there is disagreement over delaying or relocating a surgery.

from Sleep Review

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