Timothy R. Bone, President, MedMal Direct Insurance Company // March 16, 2012
In the insurance industry, the class of risk known as “Anesthesia – Pain Management” has decreased its risk exposure significantly over the last 10 years, resulting in a major reduction in medical malpractice premiums, well beyond the reduction generated by the market itself. This has not only been due to increased efficiency of the equipment, but has also been due to the outstanding clinical training today’s Anesthesiologists have received.
The following review process is offered to assure that the data entered in the Anesthesiology Report is concordant with the data entered in the medical record and the operating room log, so that the Anesthesiology Report may be used to fully support and defend these highly educated, experienced and caring healthcare providers.
Issue: Contradictory statements appearing on anesthesiology records.
Solution: In all operating rooms the Anesthesiologist (or Nurse Anesthetist, with oversight by the Anesthesiologist) is expected to complete an Anesthesiology Report with certain data being entered on a periodic basis. The primary goal is to assure that the data being entered in the Anesthesiology Report is concordant with other data being entered in the medical record and the operating room log.
Review Procedure: 1. Obtain a listing of 30 patients recently discharged from the hospital after an operating room event. 2. Secure a copy of the Anesthesiology Report from each of the medical records and, with the assistance of the medical records librarian, review each report for the timing of the data entered – such as the start of the operation, the end of the operation, or the point at which a significant clinical event began. 3. Also review other possible details, such as the signature of more than one Anesthesiologist or Nurse Anesthetist, the comments of the circulating nurse, and the timing of such things as the start of the operation, the end of the operation and the administration of blood, all of which may be mentioned in the operating room log.
Actions to Be Taken: 1. If all is in order, so notify the Medical Executive Committee and the medical staff at the next meeting. 2. If problems exist, devise a solution with the cooperation of the hospital risk manager or administrator, implement it, and re-audit the issue after approximately six months. Report the results of your re-audit to the Medical Executive Committee and medical staff.
Added Point of Emphasis: I have handled dozens of cases over the last 38 years where the data in the Anesthesiology Report did not match the data in the medical record or in the operating room log. These conflicting data entries create an unnecessary negative in the defense of the medical malpractice claim. It is usually something innocent, such as an incorrect time entry based on a wristwatch that was not reset that morning to daylight savings time; or a piece of data that has been hastily written on a paper towel, only to be lost before it can be recorded. The primary point is that the creation of doubt over the accuracy of the data entries causes cases to be settled when, with concordant data, they could have been fully defended.