The application of graph theoretical analysis to complex networks in medical malpractice: Lessons learned from China (Preprint)

BACKGROUND Studies have shown that hospitals or physicians with multiple malpractice claims are more likely to be involved in new claims; this finding indicates that medical malpractice may be clustered by institutions. OBJECTIVE We aimed to identify common factors that contribute to developing interventions to reduce future claims and patient harm. METHODS This study implemented a null hypothesis whereby malpractice claims are random events—attributable to bad luck with random frequency. As medical malpractice is a complex issue, thus, this study applied the complex network theory, which provided the methodological support for understanding interactive behavior in medical malpractice. Specifically, this study extracted the semantic network in 6610 medical litigation records (unstructured data) obtained from a public judicial database in China; they represented the most serious cases of malpractice in the country. The medical malpractice network of China (MMNC) was presented as a knowledge graph; it employs the International Classification of Patient Safety from the World Health Organization as a reference. RESULTS We found that the MMNC was a scale-free network: the occurrence of medical malpractice in litigation cases was not random, but traceable. The results of the hub nodes revealed that orthopedics, obstetrics and gynecology, and emergency department were the three most frequent specialties that incurred malpractice; inadequate informed consent work constituted the most errors. Non-technical errors (e.g. inadequate informed consent) showed a higher centrality than technical errors. CONCLUSIONS Hospitals and medical boards could apply our approach to detect hub nodes that are likely to benefit from interventions; doing so could effectively control medical risks. CLINICALTRIAL Not applicable

Drug–Drug Interactions in Vestibular Diseases, Clinical Problems, and Medico-Legal Implications

Peripheral vestibular disease can be treated with several approaches (e.g., maneuvers, surgery, or medical approach). Comorbidity is common in elderly patients, so polytherapy is used, but it can generate the development of drug–drug interactions (DDIs) that play a role in both adverse drug reactions and reduced adherence. For this reason, they need a complex kind of approach, considering all their individual characteristics. Physicians must be able to prescribe and deprescribe drugs based on a solid knowledge of pharmacokinetics, pharmacodynamics, and clinical indications. Moreover, full information is required to reach a real therapeutic alliance, to improve the safety of care and reduce possible malpractice claims related to drug–drug interactions. In this review, using PubMed, Embase, and Cochrane library, we searched articles published until 30 August 2021, and described both pharmacokinetic and pharmacodynamic DDIs in patients with vestibular disorders, focusing the interest on their clinical implications and on risk management strategies.

Spine-Related Malpractice Claims in China: A 2-year National Analysis

Study design Retrospective cross-sectional study. Objective To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period. Methods The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff’s main allegations, and arbitration outcomes. Results A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff’s favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant’s favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability. Conclusion The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.