Lars Dahlgaard Hove

Analysis of deaths related to anesthesia in the period 1996-2004 from closed claims registered by the Danish Patient Insurance Association.

Background:Anesthesia is associated with complications, and some of them may be fatal. The authors investigated the circumstances under which deaths were associated with anesthesia. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anesthetic procedures, perioperative care medicine, and intensive care medicine. Methods:The authors retrospectively investigated anesthesia related deaths registered by the Danish Patient Insurance Association. Results:From 1996 to 2004, 27,971 claims were made by the Danish Patient Insurance Association covering all medical specialties, of which 1,256 files (4.5%) were related to anesthesia. In 24 cases, the patient’s death was considered to result from the anesthetic procedure: 4 deaths were related to airway management, 2 to ventilation management, 4 to central venous catheter placement, 4 as a result of medication errors, 4 from infusion pump problems, and 4 after complications from regional blockades. Severe hemorrhage caused 1 death, and in 1 case the cause was uncertain. Conclusions:Several of the 24 deaths could potentially have been avoided by more extended use of airway algorithm, thorough preoperative evaluation, training, education, and use of protocols for diagnosis and treatment.

Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims

Objective. Iatrogenic ureteral injury during pelvic surgical procedures is a well‐known complication and important cause of morbidity. The authors investigated the circumstances surrounding registered ureteral injuries in order to identify potential opportunities to prevent such injuries. Design. Evaluation of claims concerning ureteral injuries reported to the Danish Patient Insurance Association. Setting. Danish Patient Insurance Association. Sample. All registered claims for ureteral injuries from 1996 to 2006. Methods. Retrospective study of medical records and data from Danish Patient Insurance Association. Main outcome measures. Preventable ureteral injuries. Results. From 1996 to 2006, 136 submitted claims concerning ureteral injuries were registered. Among these, 73 claims were approved (54%), and compensation paid. In 44 of these, the injury was caused by negligence. Failure to dissect the ureter despite indications for this procedure was the most common type of negligence. Laparotomy procedures were associated with 107 injuries (79%) and 29 injuries (21%) were caused during laparoscopic procedures. Thirty‐four patients suffered from chronic renal dysfunction on the affected side. Only 17 of the ureteral injuries were discovered during the procedure. Conclusions. Forty‐four ureteral injuries could potentially have been avoided using established surgical practices, most importantly by exposing the ureter via dissection when indicated. Most of the ureteral injuries were discovered postoperatively.

Analysis of 127 peripartum hypoxic brain injuries from closed claims registered by the Danish Patient Insurance Association

Background. One of the most feared complications in medicine is hypoxic brain damage to a newborn. The authors investigated the circumstances of registered peripartum hypoxic brain injuries in order to identify potential opportunities to improve patient safety and prevent injuries. Methods. The authors retrospectively investigated peripartum hypoxic brain injuries registered by the Danish Patient Insurance Association. Results. From 1992 to 2004, 127 approved claims concerning peripartum hypoxic brain injuries were registered and subsequently analysed. Thirty‐eight newborns died, and a majority of the 89 surviving children suffered from major handicaps, primarily cerebral palsy. In 69 of the cases, misinterpretation of or late action on an abnormal cardiotocography (CTG) were the reasons for the majority of the hypoxic brain injuries. Conclusions. All injuries could potentially have been avoided using established obstetric practice. CTGs are often misinterpreted. In the authors’ opinion, education and training in CTG interpretation is essential. The use of ST‐analysis of the fetus ECG (STAN) could probably reduce the number of these injuries.

Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: a Danish nationwide observational study

AIM Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician involvement and 30-day survival. METHODS Observational study including persons registered with first-time OHCA of any cause in the Danish Cardiac Arrest Registry during 2005-2012. We used logistic regression analysis to assess the association between 30-day survival and involvement of a physician at any time before arrival at the hospital. Secondary outcomes were 1-year survival and return of spontaneous circulation (ROSC) before arrival at the hospital. The associations were explored in three multivariable models: a model with simple adjustment, a model with multiple imputation of missing variables, and a propensity score model where exposed subjects were matched 1:1 with unexposed subjects on a propensity score reflecting the probability of being assigned to the exposure group. RESULTS 21,165 persons with OHCA during 2005-2012 were included. Overall, 10.8% of OHCA patients with physician involvement and 8.1% of OHCA patients without physician involvement before arrival at hospital were alive after 30 days, crude odds ratio (OR)=1.37 (95% CI=1.24-1.51), adjusted OR=1.18 (95% CI=1.04-1.34). Physician involvement was also positively associated with ROSC, OR=1.09 (95% CI=1.00-1.19); and with 1-year survival, OR=1.13 (95% CI=0.99-1.29). CONCLUSION In this large population-based observational study, we found prehospital physician involvement after OHCA associated with better 30-day survival. This association was also found for ROSC, but with less certainty for 1-year survival.

Analysis of deaths among children in the period 1996-2008 from closed claims registered by the Danish Patient Insurance Association

Aim:  We investigated the death circumstances among children in the Danish healthcare system by analysing closed claims.

Closed claims from Switzerland: an important contribution to improving patient safety in anaesthesia.

Studies based on closed claims are very important in our efforts to improve patient safety. For patients, complications of anaesthesia can be compared with ‘friendly fire’. Harm is done unintentionally by somebody whose aim was to help. Patients may be seriously injured or even die due to a complication of anaesthesia, and such events may also lead to serious psychological consequences for the responsible anaesthesiologist.

Analysis of Medication-Related Deaths in Denmark

Objective. To investigate the circumstances associated with medication-related deaths. Design and Setting. This retrospective study investigated closed claims concerning medication-related deaths from 1996 to 2008 registered by the Danish Patient Insurance Association (DPIA). Results. A total of 80 were patients registered as having died because of an adverse event or error associated with a medication, and 37 of these cases were considered to have been preventable. The circumstances of the 37 deaths are described in detail in this report. Orthopaedic surgery, anaesthesiology, and internal medicine were the specialties involved in the majority of the deaths. Incorrect dosing was the cause of 17 deaths, and the use of the wrong drug caused 11 deaths. The administration of a drug despite a known allergy/intolerance or contraindication caused 6 deaths. Other 5 deaths were caused by anticoagulation medications. Methotrexate given daily by mistake caused 2 deaths. Conclusion. This study describes the circumstances of 37 preventable deaths caused by medication. Drug administration despite a known allergy, opioids, sedative, anticonvulsive medicine, and incorrect dosing and incorrect use of anticoagulants are the most important areas to be addressed in the development of future patient safety measures to reduce patient deaths caused by or related to medications.

Venous Thromboembolism as a Preventable Patient Injury: Experience of the Danish Patient Insurance Association (1996 - 2010)

The mechanism of disease in venous thromboembolsm (VTE) is mentioned, with emphasis on the rarer types of the disease. Next the conditions for approval of claims under the Danish Patient Insurance law are drawn up, and the typical situations for approval of VTE are listed. In the database of the DPIA we found 688 claims with this disease, and of these 421 were approved. The different types of VTE are examined, and the possibilities for prevention are discussed.