Lynn M. Peterson

Identification of Adverse Events Occurring during Hospitalization: A Cross-Sectional Study of Litigation, Quality Assurance, and Medical Records at Two Teaching Hospitals

STUDY OBJECTIVES To estimate the efficacy of a medical record review for identifying adverse events and negligent case suffered by hospitalized patients. DESIGN Cross-sectional study comparing an objective medical record review with information available from hospital quality assurance records as well as risk management and litigation records. SETTING Two metropolitan teaching hospitals in the northeastern United States. MEASUREMENTS AND MAIN RESULTS Using the litigation and risk management records as a criterion standard, we found that the medical record review had a sensitivity of 80% (93 of 116; 95% CI, 73% to 88%) for discovering adverse events and a sensitivity of 76% (51 of 67; 95% CI, 66% to 86%) for discovering negligent care. We estimated that record review of a random sample of hospitalizations across a geographic region would have even higher sensitivity (adverse-event sensitivity, 84%; negligence sensitivity, 80%). Moreover, we found that the adverse events we failed to discover led to less costly malpractice claims. A significant number of adverse events (20 of 172) among hospitalizations never gave rise to litigation or risk management investigation. Six of the twenty were due to negligent care. Quality assurance efforts at the level of the clinical departments in one hospital led to review of only 12 out of 82 risk management records. CONCLUSIONS The overwhelming majority of adverse events and episodes of negligent care are discoverable with the methods we used to evaluate medical records. Quality assurance efforts using similar record review methods should be further evaluated.

A New educational approach for supporting the professional development of third-year medical students

This paper describes a new course designed to support the professional development of third-year medical students. The course runs through the clinical clerkships, and has several additional features: it includes a multidisciplinary faculty; it is centrally based in the medical school; it addresses students’ values and attitudes in addition to their knowledge and skills; and it makes use of small-group learning methods, and faculty, student, and group continuity during the year. The curriculum, which addresses ethical, social, and communicative issues in medicine, plus the evaluation of students and of the course, are described.

AIDS: The Ethical Dilemma for burgeons

“ . . . Father Paneloux evoked the august figure of Bishop Belzunce during the Marseille plague. He reminded his hearers how, toward the end of the epidemic, the Bishop, having done all that it behoved him, shut himself up in his palace, behind high walls, after laying in a stock of food and drink. With a sudden revulsion of feeling, such as often comes in times of extreme tribulation, the inhabitants of Marseille, who had idolized him hitherto, now turned against him, piled up corpses around his house in order to infect it, and even flung bodies over the walls to make sure of his death. Thus in a moment of weakness the Bishop had proposed to isolate himself from the outside worldand lo and behold, corpses rained down on his head! This had a lesson for us all; we must convince ourselves that there is no island of escape in time of plague.