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Quality of Care

Journal Articles

  1. Caplan RA, Posner K, Ward RJ, Cheney FW: Peer reviewer agreement for major anesthetic mishaps. Quality Review Bulletin 14:363-368, 1988. [NLM PubMed Link] See also: Peer Review
    1. A study of the reliability of closed claims reviewer judgments about standard of care, presence or absence of human error, and the role of better monitoring in the prevention of anesthetic mishaps.
      Forty-two anesthesiologists reviewed 48 closed claim abstracts of anesthetic mishaps. The data demonstrated that anesthesiologists from widely different backgrounds can produce a cohesive set of judgments about anesthetic mishaps.
  2. Cheney FW, Posner K, Caplan RA, Ward RJ: Standard of care and anesthesia liability. JAMA 261:1599-1603, 1989. [NLM PubMed Link] See also: Project Overview
    1. The ASA Closed Claims database of 1,004 lawsuits was examined to define the impact of the "Standard of Care" as judged by practicing anesthesiologists on the likelihood and amount of financial recovery. This paper provides a general overview of the methodology of the project. The most important finding was that if the anesthesiologist provides appropriate care there is still a greater than 40% chance that payment will be made for a claim of malpractice.
  3. Caplan RA, Posner K, Cheney FW: Effect of outcome on physician judgments of appropriateness of care. JAMA 265:1957-1960, 1991. [NLM PubMed Link] See also: Peer Review. Order this article from: ASA Closed Claims Project
    1. Twenty-one cases which involved adverse anesthetic outcome were reviewed by 112 practicing anesthesiologists who were asked to judge the standard of care. Matched sets of cases were judged which differed only in outcome. A significant inverse relationship was noted between severity of outcome and appropriateness of care. For the same clinical scenario, as the severity of patient injury increased care was more apt to be judged substandard.
  4. Metzner J, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol. 2009 Aug;22(4):502-8. [NLM PubMed Link]. See also: Respiratory System
    1. This analysis of claims since 1990 compared 87 claims for anesthesia in remote locations to 3287 claims from OR procedures. Remote location claims involved older and sicker patients and utilized MAC in 50% of claims. Claims from remote locations had more severe injuries than OR claims, with a higher proportion of death and respiratory damaging events. Our data suggests that anesthesia at remote locations poses a significant risk for the patient, particularly related to oversedation and inadequate oxygenation/ventilation during monitored anesthesia care.
  5. Metzner J, Posner KL, Lam MS, Domino KB. Closed claims analysis. Best Pract Res Clin Anaesthesiol. 2011 Jun;25(2):263-76. [NLM PubMed Link] See also: Monitoring - Physiology, Project Overview, Regional / MAC, Respiratory.
    1. The profile of anesthesia liability changed over the decades, including the types of anesthesia care associated with claims as well as events and injuries leading to claims. The most common complications in 1990-2007 were death, nerve injury and permanent brain damage. The most common anesthesia-related events leading to claims were regional-block related, respiratory, cardiovascular and equipment-related. This review includes focus on liability related to the difficult airway, monitored anesthesia care, non-operating room locations, obstetric anesthesia, and chronic pain management
  6. Lee LA, Stephens LS, Fligner CL, Posner KL, Cheney FW, Caplan RA, Domino KB. Autopsy Utilization in Medicolegal Defense of Anesthesiologists. Anesthesiology. 2011 Oct;115(4):713-717. Accompanied by an editorial by McLemore JL and Garvin AJ: Autopsy and malpractice considerations. Anesthesiology 2011 October 115 (4): 685-6.
    1. Claims for deaths with evaluable autopsies were compared with deaths without autopsy from 1990 and later taken from the ASA Closed Claims Project database. Autopsy findings were helpful for the defense in 55% and harmful in 27% of the claims against anesthesiologists. Two thirds of evaluable claims indentified a significant non-anesthetic contribution to death.

Newsletter Articles

  1. Caplan RA, Posner KL: Informed consent in anesthesia liability: Evidence from the Closed Claims Project. ASA Newsletter 59(6):9-12, 1995. [Full Text]
  2. Cheney FW: The changing pattern of anesthesia-related adverse events. ASA Newsletter 60(6):10-13, 1996. [Full Text]
  3. Cheney FW: Anesthesia patient safety and professional liability continue to improve. ASA Newsletter 61(6):18-20, 1997. [Full Text] See also: Malpractice System
  4. Caplan, RA: Informed Consent: Patterns of Liability from the ASA Closed Claims Project. ASA Newsletter 64(6):7-9, 2000. [Full text; PDF Version]
  5. Posner, KL: Liability Profile of Ambulatory Anesthesia. ASA Newsletter 64(6):10-12, 2000. [Full Text; PDF Version]
  6. Lee LA: Autopsy: a fading investigative tool. ASA Newsletter 72(11): 35-6, 2008.
  7. Metzner JI: Risks of anesthesia at remote locations. ASA Newsletter 74(2): 17-18, 2010. [Full Text; PDF Version] See also: Respiratory System
  8. Metzner J, Domino KB: Risks of anesthesia care in remote locations. Anesthesia Patient Safety Foundation (APSF) Newsletter 26(1):5-6, 2011. See also: Respiratory System