The risk of fatal bleeding complications in jugular catheterization in patients with coagulopathy: A retrospective analysis of death cases in closed claims and the Medical Accident Investigating System in Japan

Background To prevent recurrence of medical accidents, the Medical Accident Investigating System was implemented in October 2015 by the Japan Medical Safety Research Organization (Medsafe Japan) to target deaths from medical care that were unforeseen by the administrator. Medsafe Japan analyzed the 10 cases of central venous catheterization-related deaths reported in the system and published recommendations in March 2017. However, the particular emphasis for the prevention of central venous catheterization-related deaths is unclear. Methods This study aimed to identify the recommendation points that should be emphasized to prevent recurrence of central venous catheterization-related deaths. We assessed central venous catheterization in 8530 closed-claim cases between January 2002 and December 2016 covered by the medical insurer Sompo-Japan. Moreover, we compared central venous catheterization-related death in closed-claim cases with death in reported cases. Results The background, error type, anatomic insertion site, and fatal complication data were evaluated for 37 closed-claim cases, of which 12 (32.4%) were death cases. Of the 12 closed-claim cases and 10 reported cases, 9 (75.0%) closed-claim cases and 9 (90.0%) reported cases were related to vascular access. Among these, 5 closed-claim cases (41.7%) and 7 reported cases (77.8%) were related to internal jugular vein catheterization (p = 0.28). Coagulopathy was observed in 3 (60.0%) of 5 closed-claim cases and 6 (85.7%) of 7 reported cases. Conclusions The risk of internal jugular catheterization in patients with coagulopathy must be carefully considered.

Smart syringe using actuator and force sensor for epidural anesthesia injection

The anesthesia process in the epidural space is quite difficult as it requires a high level of skill. Therefore, a medical accident occurs, and intensive training is required. In order to reduce these medical accidents, medical technology is being developed, which provides safe and accurate treatment services. This paper proposes a smart syringe design for safe and accurate anesthesia in the epidural space. The smart syringe is designed to measure the electrical sensing waveform by using a sensor instead of the sense of the hand during anesthesia and show the position of the needle through external monitoring. To design a smart syringe, a force sensor, actuator, and CPU were used, and a 3D printer was used to produce the outer shape. An animal test was conducted to evaluate the performance test of the smart syringe, and satisfactory results were obtained by measuring the needle insertion process of the smart syringe and the position of the needle through the animal experiment.

A Questionnaire Based on A Sub-Regional Hierarchical Level Showed the Following: Application of Medical Accident Insurance is Suitable in Shanghai, China

Background: The application of medical accident insurance could not only cover parts of patients’ property loss caused by non-medical negligence, but also reduce the risks of medical staff during medical services. However, the compensation mechanism for medical accidents is unsound in china. Methods: In order to figure out the awareness and acceptance of the medical accident insurance in Shanghai medical institutions, medical staff and patients, a questionnaire survey was conducted. The feedback, which in total came from 22 medical institutions, 1,689 medical staff and 1,342 patients, was statistically analyzed by chi-square test.Results：Only 22.72% of the 22 hospitals in this questionnaire survey purchased medical accident insurance. As a result, medical accident insurance only accounts for 3.13% of medical compensation, which was far lower than the negotiated compensation ratio (61.25%) and the medical liability insurance compensation ratio (14.38%). This may be due to the low awareness of medical accident insurance, and our survey also proves this phenomenon. In this survey, we find that only a small proportion (22.73%) of medical institutions purchase medical accident insurance. What is more unexpected is that the vast majorities of patients (50.00%) and medical workers (64.00%) have only heard of it and are not aware of it. Although nearly half of the patients (45.16%) and medical workers (58.26%) are willing to buy medical accident insurance, there were still some patients and medical workers who were uncertain (32.80% and 38.82%, respectively) or unwilling to buy it (8.94% and 16.02%, respectively). The reason is nothing more than that no benefits will occur while the cost is high. Among those willing to buy, the majority of the patients (58.19%) and medical workers (54.39%) only accept the amount of insurance less than RMB 200 yuan. Conclusions: The acceptability and cognition of medical accident insurance in medical workers and patients are still at a low level in Shanghai. In addition, preliminary data from medical institutions purchasing medical accident insurance shows that the insurance can effectively reduce medical disputes and ease economic burden. To sum up, medical accident insurance has good application prospect and space in Shanghai, China.

The Social And Economic Cost Of Sleep Disorders

Study Objectives To estimate economic cost of common sleep disorders in Australia for 2019–2020. Methods Costs were estimated for obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) using prevalence, financial, and nonfinancial data from national databases. These included: (1) financial costs associated with health care, informal care, productivity losses, non-medical accident costs, deadweight loss from taxation/welfare inefficiencies; and (2) nonfinancial costs associated with loss of well-being. They were expressed in US dollars ($). Results Estimated overall cost of sleep disorders in Australia in 2019–2020 (population: 25.5 million) was $35.4 billion (OSA $13.1 billion; insomnia $13.3 billion, RLS $9.0 billion). Of this, the financial cost component was $10.0 billion, comprised of: health system costs $0.7 billion; productivity losses $7.7 billion; informal care $0.2 billion; other, mainly non-medical accident costs, $0.4 billion; and deadweight losses $1.0 billion. For moderate to severe OSA syndrome, insomnia unrelated to other conditions and RLS, financial costs represented $16,717, $21,982, and $16,624 per adult with the condition for the year, respectively. The nonfinancial cost was $25.4 billion. Conclusions The economic costs associated with sleep disorders are substantial. The financial component of $10.0 billion is equivalent to 0.73% of Australian gross domestic product. The nonfinancial cost of $25.4 billion represents 3.2% of total Australian burden of disease for the year. Health system costs of these disorders are low relative to those associated with their consequences, suggesting greater expenditure on detection, treatment and prevention is warranted.

Assisting beginners in root cause analysis operations: analysis and recommendations regarding the spread of COVID-19 in nursing facilities for the elderly

BackgroundTo analyse a medical accident, much time and experience are needed. However, people without experience in analysis have difficulty understanding its conditions and methods, and as a result it takes longer to establish countermeasures. It must be noted that understanding conditions by simply aligning occurrences in the accident in a chronological order is difficult.PurposeA workflow chart that considers time was proposed so that individuals without adequate experience in analysis could easily carry out root cause analysis.MethodsIn the ‘workflow chart (WFC)’, the time sequence was described horizontally. On the vertical axis, the business manual, the occurrence of the accident, and the time of the occurrence are displayed. In the bottom column of patient event, information regarding damage to patients was written in accordance with time axis. Regarding the degree of damage, the time of error until the accident was identified was connected using a straight line (when the patient was not affected, a dotted line was used) in order to show the overall picture of the accident.ResultsAccording to the time flow chart, hints to identify potential risks were proposed. Focus was placed not only on the error event, but also on keywords such as manual inadequacy, time gap, degree of error and so on to easily lead to the question ‘why?’ To visualise this, I proposed an operation flow chart. By using time-WFC, even beginners can easily develop accident countermeasure strategies.ConclusionUsing a WFC that considers time, time of error and the occurrence of accident could be visualised. As a result, even individuals without experience in analysis could easily perform an analysis.

No-fault Law on Medical Accidents in Belgium: An Evaluation after Six Years

After many years of criticism of the medical malpractice system based on negligence, Belgium introduced a law on medical accidents in March 2010. This law created a Medical Accidents Fund. Under this two-track system the victim of a medical accident has the choice to file a claim before the court or to seek compensation from the Fund. The Law on Medical Accidents has four objectives: (1) to create a Fund with a simple and fast procedure that is cost-free to access, (2) to channel and centralise all medical accident claims to the Fund, and to develop a prevention strategy, (3) to compensate more victims by introducing a personal right to compensation for medical accident victims without the need to consider liability, and finally, (4) to achieve a balanced budget. A medical accident without liability can be defined as an accident caused by healthcare which does not lead to the liability of a caregiver, does not result from the patient’s health condition and causes abnormal damage to the patient. The damage is abnormal if it was not supposed to occur given the current state of scientific knowledge, the patient’s health condition and its objectively predictable evolution. Following analysis of the new law, this study shows that it has created a single, central point of contact that is easily accessible and generally understood by medical accident victims. On average fifty new cases a month are submitted to the Fund. In a reasonable number of cases to date, liability of the caregiver has been accepted by the Fund. However, the Fund is rather strict in awarding no-fault compensation for medical accidents without liability. It remains to be seen whether this interpretation can resist the test of judicial review.

ON THE ISSUE OF EXEMPTING A MEDICAL ORGANIZATION FROM RESPONSIBILITY FOR DAMAGING A PATIENT'S HEALTH

This article discusses the urgent issue of the grounds for exempting a medical organization from liability for harming the patient’s health. The authors point out the imperfection of the legislation in the sphere of norms governing the grounds for both full and partial exemption from civil liability, due to the lack of concretization and legal determination of the necessary categories. The absence in the legislation of a clear definition of such categories as “medical error”, “medical accident”, and “justified medical risk” contributes to contradictions in the assessment of the actions of medical workers and the conclusions of the court. The authors propose making changes that will help improve the legislation on this issue