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Medico-Legal Risks Definition

As regards objective (ii), there are many reasons for non-notification to the SE before carrying out the forensic analysis. One of the reasons is related to the definition of serious harm as a prerequisite for the qualification of the event as a “sentinel”. Nevertheless, the damage in all its gravity can manifest itself after several days or even years after the critical event: its true meaning cannot therefore be understood at first. Genovese U, Del Sordo S, Casali MB. Clinical competence: stato dell`arte e proiezioni medico-legali. Rivista Italiana di Medicina Legale e del Diritto in campo sanitario 2012;33:123–139. The laws are different in different countries, so it is impossible to write a definitive forensic guide that will apply in each country. This article contains simplified explanations of important medico-legal concepts that are widely accepted around the world. The analysis of medico-legal disputes proves to be an excellent tool of high accuracy and reliability, useful to detect situations previously undetected by CRM professionals and registered as an SE. It is not possible for all doctors to work in a medical advocacy organization, but perhaps it could be advantageous for physicians in a broader sense to pull the forensic bogeyman out of the bed and illuminate it, with unknown fears and imaginary consequences that are often far worse than reality. Instead of cynically seeing this as doctors becoming advocates and distancing them from clinical medicine, we can see it in the same way as my patient, rather than taking responsibility and better managing and understanding the stress inherent in risk.

Our research has shown that the forensic expert – even if limited to cases that have given rise to litigation – has the privilege of being able to use case analysis as they evolve over time. In particular, with regard to item (i) of the objectives of this study, it can be said that the analysis of medico-legal disputes has been characterized by excellent precision; indeed, we did not miss a single case in the case of the SE, which had established a claim for medical liability and had already been reported. Table 3 gives a schematic description of the 16 SEs, which results from the medico-legal analysis of the dispute. The 7 cases that are not registered in the CRM database (numbers 1, 5, 7, 10, 11, 12 and 15) are highlighted in grey. The Italian National Health System (NHS) delegates part of the CRM functions to the new health information system (Nuovo Sistema Informativo Sanitario (NSIS)), which monitors the occurrence of socio-economic compensation and malpractice claims and, as a secondary objective, develops health guidelines and specific measures to prevent or minimise risks [4]. Table 1 contains the list of ES according to a document from the Italian Ministry of Health [5]. The same document states that ES are also the events that determine serious harm with clinical outcomes or conditions that significantly affect the health care pathway. These specific conditions are presented in Table 2. The definition of “patient” is interpreted broadly; A duty of care may exist between physicians and future patients, and even between medical administrators and inpatients. Forensic dispute analysis is a valuable tool to improve the reporting of “sentinel events”. One possible proposal is to implement an organizational model to establish a rapid procedure for reporting sentinel events when assessing medico-legal disputes.

The forensic approach, through its particular method of analysis, drew attention to high-profile OS, which had not been detected before with the usual CRM tools. In the field of advanced health services, a key objective is to promote a culture of safety and clinical risk management. In this regard, Sentinel event reporting is part of a failure analysis perspective and attempts to propose solutions to prevent the malicious event from happening again. The purpose of this study is to analyze the contribution of medico-legal litigation in clinical risk management and to propose an organizational model to coordinate the intervention of clinical risk management and medico-legal services. When I joined Avant as a medical advisor in training, people asked me if my stress levels related to practicing medicine had increased. Perhaps they thought that immersion in the forensic world would bring to the surface the fears inherent in medicine by surrounding me with memories of our common professional vulnerability as physicians. The answer to this question is both “yes” and “no”. Ensuring that the stressors surrounding clinical decision-making in the medico-legal context remain at constructive levels requires more than just action by physicians. Systemic changes to complaint processes are important to increase transparency, efficiency and fairness.

On an individual level, however, it helped me gain a deeper understanding and thus the confrontation with the forensic world.

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