Published: August 2023
At the end of 2021, 228 CMPA members were vascular surgeons (Type of Work 89). In the recent 5 years (2017 – 2021)1, 27.3% of vascular surgeons were named in 1 new medico-legal case (legal action, College complaint, or hospital complaint), and an additional 9.6% were named in 2 or more new cases on average.
Annually, 9.2% of vascular surgeons were named in 1 new medico-legal case, and an additional 1.7% were named in 2 or more new cases on average across this 5-year period.
What are the relative risks of a medico-legal case for vascular surgeons?
With the exception of 2016 and 2017, vascular surgeons had generally simiar rates of legal actions when compared to all surgical specialties.
Vascular surgeons had generally similar rates of College matters2 when compared to all surgical specialties prior to 2019. In recent years, vascular surgeons had lower rates of College matters.
The following sections describe the findings based on the 147 civil legal cases, College, and hospital matters involving vascular surgeons with peer expert criticism that were closed by the CMPA between 2011 and 2021.
What are the most common patient complaints and peer expert criticism?3 (n=147)
|Failure to perform test or intervention
|Inadequate monitoring or follow-up
|Inadequate consent process
|Communication breakdown with patient
|Injury associated with healthcare delivery
|Failure to refer
|Poor decision-making regarding patient mgmt
Complaints are a reflection of the patient’s perception that a problem occurred during care. These complaints are not always supported by peer expert opinion. Peer experts may not be critical of the care provided, or may have criticisms that are not part of the patient allegation.
What are the most frequent interventions with peer expert criticism? (n=147)
The most common peer expert criticisms on these interventions include:
- Deficient assessment
- Poor decision-making regarding patient management (e.g. delay in performing an intervention)
- Deviation from administrative procedure (e.g. failure to implement or use a test follow-up system)
- Inadequate monitoring or follow-up
- Communication breakdown with other physicians
- Inadequate documentation
What are the top factors associated with severe patient harm4 in medico-legal cases? (n=147)
- ASA status 3 or above6
- Personal history of major surgery, implants, or grafts
- Failure to order diagnostic testing (e.g. CT, MRI, angiogram)
- Failure to perform surgery in a timely manner related to an inadequate patient assessment or hospital capacity issues
- Deviation from administrative procedure (e.g. misfiled test results)
Risk reduction reminders
The following risk management considerations have been identified in reviewing CMPA cases for vascular surgeons.
- Gather an appropriate medical history from the patient, including co-morbidities and current medications, and conduct a focused physical examination including vital signs. Consider relevant risk factors and their impact on the patient’s surgery.
- Document discussions about informed consent, treatment plans, and other clinical issues in patients’ medical records. This can improve continuity of care by communicating to other providers what took place during a patient encounter and the rationale for clinical decision-making.
- Consider the risks of intra-operative injuries during the procedure, and protect vital structures to mitigate this risk. When appropriate, document any efforts to visualize or protect these structures.
- Have a reliable system in place to facilitate the timely receipt, effective review, and appropriate management and follow-up of diagnostic tests.
- Assess the patient following surgery and carefully document the patient’s condition. Be alert to signs of post-operative complications. Thoroughly investigate any post-procedural complaints by patients and respond appropriately in a timely fashion. Ask team members (e.g. nurses, residents) to alert you of unexpected signs and symptoms.
- In the event of a complication, ensure it is disclosed to the patient in a timely manner, and that the discussion is documented in the medical record.
CMPA medico-legal cases represent a small portion of patient safety incidents. Many factors influence a person’s decision to pursue a case or file a complaint, and these factors vary greatly by context. Thus, while medico-legal cases can be a rich source for important themes, they cannot be considered representative of patient safety incidents overall.
Further, CMPA’s medico-legal cases data focus on provider and team factors. System factors are underrepresented.
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It takes an average of 2-3 years for a patient safety incident to progress into a medico-legal case. As a result, newly opened cases may reflect incidents that occurred in previous years.
Physicians voluntarily report College matters to the CMPA. Therefore, these cases do not represent a complete picture of all such cases in Canada.
Peer experts refer to physicians who interpret and provide their opinion on clinical, scientific, or technical issues surrounding the care provided. They are typically of similar training and experience as the physicians whose care they are reviewing.
Severe patient harm includes death, catastrophic injuries, and major disabilities. Healthcare-related harm could arise from risk associated with an investigation, medication, or treatment. It could also result from failure in the process of patient care.
Patient factors include any characteristics or medical conditions that apply to the patient at the time of the medical encounter, or any events that occur during the medical encounter.
The American Society of Anesthesiologists (ASA) Physical Status Classification System is used by physicians to predict a patient’s risks ahead of surgery. ASA status 3 indicates severe systemic disease.
Based on peer expert opinions. These include factors at provider, team, and system levels. For vascular surgery cases, there is no evidence for any team-level or system-level factors in the data.