Patient Safety in Neurosurgical Practice: Physician and Patient Factors that Contribute to Patient Injury

Christopher L. Taylor, Darrell Ranum

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background Recommendations that may help reduce adverse events outside the perioperative period are uncommon. We identified the primary factors that contributed to patient injury in neurosurgical practice both within the perioperative period and outside the perioperative period. Methods Medical malpractice claims (n = 355) from The Doctors Company that were closed over 7 years were reviewed by neurosurgical medical experts. Objective neurosurgical expert analysis of the cases identified patient injuries and the primary factor that contributed to the patient injury. Results Continued pain, nerve damage, and need for additional surgery were the most common injuries. In 145 cases (40.8%), the primary factor that contributed to patient injury occurred outside the perioperative period: assessment (evaluation and diagnosis), selection and management of therapy, and communication between the physician and patient/family. In 138 (38.9%) cases, the primary factor that contributed to patient injury occurred within the perioperative period. Surgical complication (a known risk of the procedure) was the primary factor in 99 cases (27.9%), and technical performance of surgery was the primary factor in only 39 cases (11.0%). Conclusions In addition to excellent surgical technique, checklists, teamwork, outcomes measurement, and regionalization of subspecialty care, improving patient safety in neurosurgical practice requires careful attention to care provided outside the perioperative period. Differential diagnosis, consideration of all relevant clinical data, active pursuit of good physician–patient relationships, and adequate monitoring of patients receiving nonsurgical treatment may also help improve patient safety in neurosurgical practice.

Original languageEnglish (US)
Pages (from-to)159-163
Number of pages5
JournalWorld Neurosurgery
Volume93
DOIs
Publication statusPublished - Sep 1 2016
Externally publishedYes

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Keywords

  • Adverse events
  • Complications
  • Liability
  • Medical error
  • Neurosurgery
  • Patient safety

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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