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.

   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.

   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.

   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.

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]