From the Journals

How anesthesia in the GI endoscopy suite contributes to endoscopy malpractice



In a study of anesthesia medical malpractice cases involving gastrointestinal endoscopies, endoscopic retrograde cholangiopancreatography (ERCP) was the procedure that most often resulted in payouts to plaintiffs.

Lead author Alexander B. Stone, MD, of Brigham and Women’s Hospital, Boston, and his colleagues examined 58 malpractice cases involving anesthesia providers between January 2007 and December 2016 from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System, a database representing about 30% of annual malpractice cases in the United States. Of these cases, 48% were associated with esophagogastroduodenoscopy, 19% involved ERCP, 14% resulted from colonoscopies, 14% stemmed from combined esophagogastroduodenoscopy and colonoscopy, and 5% involved endoscopic ultrasound. Investigators found that 91% of ERCP cases resulted in a payment to plaintiffs, compared with 37.5% of colonoscopy cases, 25% of combined esophagogastroduodenoscopy/colonoscopy cases, 21% of esophagogastroduodenoscopy cases, and 0% of endoscopic ultrasound cases, according to the study published in the April 24 Journal of Clinical Anesthesia.

Of all 58 claims, the mean payment was $99,754. When restricted to only claims that resulted in payment (22 cases), the mean payment rose to $275,510, and the median payment was $7,170. No significant difference existed in the percentage of cases that resulted in payment between high-, middle-, and low-severity cases.

The most common contributing factors to the alleged anesthesiology-related adverse events were lack of technical skill, clinical judgment errors, communication mishaps, and documentation problems. Within the technical skill category, technical problems from a known complication, poor technique, and failure to resuscitate were frequent contributing factors. Within the clinical judgment category, failure to monitor the physiological status of the patient was the most common subcategory noted.

Oversedation was another possible contributing factor in 62.5% of the cases, investigators found. For the purposes of this study, oversedation was defined as unexpected changes in the physiological state of the patient and/or unplanned intubation for a patient undergoing monitored anesthesia care. But the authors concluded that oversedation alone did not lead to liability for anesthesia providers practicing in the endoscopy suite; rather, it was allegations of technical and clinical judgment failures, such as the inability to recognize acute clinical deterioration or manage difficulty, that most often resulted in settlements to plaintiffs. The analysis also suggested that even when adverse events occured in the endoscopy suite, anesthesiologists were less likely to be found liable when highly trained and well-equipped anesthesia providers were readily available.

The authors concluded that it is critical to have a well-prepared anesthesia provider when medically complex patients are undergoing endoscopic procedures.

The authors had no disclosures.

SOURCE: Stone AB et al. J Clin Anesth. 2018 Apr 24;48:15-20.

* This story was updated on June 7, 2018.

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