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Coming to Terms with Patient Safety

By Jock Hoffman, CRICO

Related to: Ambulatory, Clinical Guidelines, Emergency Medicine, Primary Care, Nursing, Other Specialties, Surgery

“Incomprehensible jargon is the hallmark of a profession.”Kingman Brewster, Jr.

If CRICO’s effort to lead you to opportunities for safer patient care is derailed by jargon and ambiguity, then we’ve begun the journey with a misstep. To enable you to translate malpractice data into decisions that help you stratify your risks and prioritize your action plans, we thought we should decipher some of the patient safety argot. For starters, here are several of the most commonly used “inside baseball” terms employed by CRICO and others in the patient safety community.

Adverse Event: The result from medical management in which the outcome was unforeseen and unexpected. While it can represent an injury caused by medical treatment that is not necessarily due to an error or omission, CRICO generally uses the term to identify events involving at least an allegation of substandard care.

Allegation: A malpractice claim or lawsuit may assert multiple allegations, however, CRICO identifies the single allegation that best characterizes what the case is about. Similar allegations are bundled into categories (e.g., diagnosis-related, surgery-related, obstetrics-related) that lend themselves to focused patient safety improvement efforts.

Clinical Judgment: Used by CRICO as a Contributing Factor category for questionable decision making (by physician and non-physicians) in areas such as: patient assessment, selection/management of therapy, patient monitoring, seeking a consult/referral, ensuring the patient's safety, and factors that affect the caregiver, such as distractions, multitasking etc.

Comparative Benchmarking: Examining the malpractice data of a single department, organization, or insurer in relation to similar data from a peer or a cluster of peers. CRICO maintains an extensive comparative benchmarking database, with more than 200,000 malpractice cases from more than 500 organizations across the United States.

Contributing Factors: CRICO codes every case for a broad array of clinical and environmental factors which may have contributed to allegations, injuries, or initiation of the claim. In general, these areas reflect issues that are amenable to risk reduction strategies.

Diagnosis-related: A malpractice category designated by CRICO for cases stemming from an alleged error in diagnosis or testing that delayed appropriate treatment or surgery. This type of case covers system-attributable, clinician-attributable, and patient-attributable causes.

High-severity: CRICO codes all malpractice cases with an injury severity rating derived from the National Association of Insurance Commissioners. High severity encompasses cases with significant permanent injuries and death. In addition to being the most devastating events for patients and families (and clinicians), high-severity cases are the most likely to be closed with a payment and the most costly.

Initiatives/Interventions: Efforts to change or introduce clinical systems or behaviors in order prevent the recurrence of preventable adverse events. In patient safety circles, the terms are sometimes interchanged with "best practices."

Responsible Service: The clinical service of the (physician or non-physician) provider responsible for the patient’s care at the time of the event that triggered a malpractice claim or suit.

The field of patient safety employs many more terms that can leave the uninitiated spending more time deciphering the lingo than pondering the message. If you have some that leave you baffled, you’re probably not alone, so please let us know what else we can help make clear.

September 1, 2011
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