In over a century of providing advice and assistance to physicians, the CMPA has accumulated the largest collection of physician-related medico-legal data in the world. Using innovative quantitative and qualitative analysis techniques, the CMPA is able to gain insights and identify gaps that affect safe care.
In 2016, the CMPA established an evidence synthesis team comprised of researchers, physicians, nurses, and statisticians. The group investigates the current state of scientific evidence to gain a fulsome understanding of the patient safety landscape and to help shape the CMPA’s work in safe medical care.
In the past, we have shared insights with members through risk management information and education. Today, we are also sharing our findings by publishing in peer-reviewed journals.
We look forward to making our research available to physicians and researchers working in quality improvement, patient safety and medical education to empower safe medical care.
Medico-legal Closed Case Trends in Canadian Plastic Surgery: A Retrospective Descriptive Study
This paper provides a retrospective descriptive analysis of the characteristics of medico-legal cases involving specialist plastic surgeons over a 5-year period. This study describes the medico-legal landscape in Canadian cosmetic and non-cosmetic plastic surgery, highlighting the importance of strong physician–patient communication, patient education, and informed consent in preventing complaints.
Zhang Z, Calder LA, Finestone PJ, Liu R, Bucevska M, Arneja JS. Medico-legal closed case trends in Canadian plastic surgery: a Retrospective Descriptive Study. PRS Global Open. 2021; 9(8): e3754. doi: 10.1097/GOX.0000000000003754
Intraoperative injuries from abdominopelvic surgery: an analysis of national medicolegal data
This 5-year analysis of CMPA closed cases described the frequency and types of injury, clinical management and outcomes, and the contributing factors—both technical and nontechnical including the impact of documenting informed consent.
Lefebvre G, Devenny KA, Héroux DL, Bowman CL, Neilson HK, Mimeault R, Singh SS, Calder LA. Intraoperative injuries from abdominopelvic surgery: An analysis of national medicolegal data. Can J Surg. 2021 Mar 5;64(2):E127-E134. doi: 10.1503/cjs.010219
Medico-Legal Cases Involving Cardiologists and Cardiac Test Underuse or Overuse
This study showed that across 10 years of closed CMPA medico-legal cases, there were no peer expert criticisms of cardiologists for cardiac diagnostic test overuse, despite potential harms from overuse. Criticisms of cardiac test underuse were rare and related to issues with diagnosing symptomatic patients.
Calder LA, Neilson HK, Whyte EM, Ji J, Bhatia RS. Medico-legal cases involving cardiologists and cardiac test underuse or overuse. CJC Open. 2020 Dec 1;3(4):434-441. doi: 10.1016/j.cjco.2020.11.018
The medico-legal helpline: A content analysis of postgraduate medical trainee advice calls
This paper used CMPA advice calls to explore the frequency of and reasons behind why trainees called the Association. Our study found that physicians-in-training are calling the CMPA with increasing frequency, with the most common issue relating to managing confidential information, complex care situations, academic matters and patient safety incidents.
McDougall A, Zaslow J, Zhang C, Yang Q, Nuth J, Tsai E, Lee S, Lefebvre G, Calder L. The medico-legal helpline: A content analysis of postgraduate medical trainee advice calls. Medical Education. 2020; 00:1-7.
Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association
This paper provides a retrospective descriptive analysis of the contributing factors in medico-legal cases involving specialist anesthesiologists where airway management was a central issue, highlighting the importance of adherence to clinical practice guidelines.
Crosby ET, Duggan L, Finestone P, Liu R, De Gorter R, Calder LA. Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association. Can J Anesth/J Can Anesth [Internet]. 2020 Nov 16 [citied 2020 Dec 9]. Available from: https://doi.org/10.1007/s12630-020-01846-7
Quality improvement initiatives in areas of practice with high medical-legal risk in obstetrical care: A systematic review
This paper reviews published evaluations of obstetrical quality improvement initiatives and identifies those that addressed areas of high medical-legal risk for physicians providing obstetrical care.
Calder LA, Bowman CL, De Gorter R, Wright E, Yang Q, Lefebvre G. 2020. Quality improvement initiatives in areas of practice with high medical-legal risk in obstetrical care: A systematic review. Unpublished manuscript, Canadian Medical Protective Association.
Implementing Obstetrics Quality Improvement, Driven by Medico-legal Risk, is Associated With Improved Workplace Culture
This paper reports the findings from a collaborative, quality improvement program based on CMPA knowledge of medico-legal risk in obstetrics, and the impact of the program on workplace culture.
Lefebvre G, Honey L, Hines K, Keough A, Roye C, Bellemare S, Piscione TD, Falconer A, Shepherd L, Thorne S, Wallace G, Calder LA. Implementing Obstetrics Quality Improvement, Driven by Medico-legal Risk, is Associated With Improved Workplace Culture. J Obstet Gynaecol Canada [Internet]. 2020 January [cited 2020 January 14]; 42(1): 38-47.e5. Available from: https://doi.org/10.1016/j.jogc.2019.05.011
A Quality Indicator Framework for High-Risk Areas in Obstetrical Care
This study describes the development of a set of quality improvement indicators for areas of practice associated with increased medical-legal risk in order to support measurable improvements in obstetrical practice. It illustrates the importance of balancing measures when creating quality metrics, as well as providing practical quality indicators for quality improvement teams and researchers to engage in improvements in obstetrics quality of care.
Calder LA, Bowman CL, Yang Q, Gondocz T, Young C, Zhang C, MacIntyre A, Darling R, O’Neill JP, Roye C, Lefebvre, G. 2019. A quality indicator framework for high-risk areas in obstetrical care. Unpublished manuscript, Canadian Medical Protective Association.
Surgical Fires and Burns: A 5-Year Analysis of Medico-legal Cases
This paper provides a retrospective descriptive analysis of the contributing factors in medico-legal cases involving surgical fires and burns in Canada over a 5-year period. This study highlights a need for improved surgical safety interventions to address surgical fires and burns.
Calder L, Héroux D, Bernard C, Liu R, Gilchrist A, Neilson HK, Gilchrist AD, Fish J. Surgical fires and burns: a 5-year analysis of medico-legal cases. J Burn Care Res. 2019:1-7. [epub ahead of print]
Recommendations from the National Panel on Quality Improvement in Obstetrics
This paper describes the recommendations of a national panel on quality improvement in obstetrics to identify priorities for action among five areas of greatest medico-legal risk. Using previously conducted medico-legal data analyses and a systematic literature review, the panel reviewed existing data and developed recommendations for areas of focus in quality improvement in five obstetrical high-risk areas. The panel recommended clarification of definitions in some areas, identified needs for data collection and standardization of practices in others. The most promising interventions to improve care in the five areas were grouped into: standardized processes (such as protocols and communication tools), checklists, audit and feedback, mentoring and coaching, inter-professional communication, simulation and training, and shared decision making guides. This national panel of experts created 18 action-oriented recommendations focused on quality improvement to reduce medico-legal risk and improve the safety of care for Canadian mothers and babies.
Lefebvre G, Calder LA, De Gorter R, Bowman CL, Bell D, Bow M, et al. Recommendations from a National Panel on Quality Improvement in Obstetrics. J Obstet Gynaecol Canada [Internet]. 2019 May [cited 2019 May 9]; 41(5):653–9. Available from: https://www.jogc.com/article/S1701-2163(19)30086-6/fulltext
Using medicolegal data to support safe medical care: A contributing factor coding framework (article)
This methodological paper discusses a new patient safety-informed framework developed by the CMPA, which acknowledges the effects of team, organizational, and system factors, in addition to physician care. This new approach revolutionizes the way the CMPA codes its medical-legal data, and improves understanding of the many factors that contribute to patient safety events.
McCleery A, Devenny K, Ogilby C, Dunn C, Steen A, Whyte E, et al. Using medicolegal data to support safe medical care: a contributing factor coding framework. J Healthc Risk Manag [Internet]. 2018 Aug 3 [cited 2018 Nov 19]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/30074677
Improved hospital safety performance and reduced medico-legal risk: an ecological study using two Canadian databases (article)
This paper analyzes two Canadian databases, the CMPA and the Discharge Abstract Database, to determine if there was a relationship between in-hospital patient safety events and medico-legal cases involving physicians in Canada. This study is novel in that there are very few like it based on Canadian data and it shows the practical use for medico-legal and patient safety data, which can be used to improve patient safety and quality of care.
Yang Q, Zhang C, Hines K, Calder LA. Improved hospital safety performance and reduced medicolegal risk: an ecological study using 2 Canadian databases. CMAJ Open [Internet]. 2018 Nov 19 [cited 2018 Nov 23];6(4):E561–6. Available from: http://cmajopen.ca/lookup/doi/10.9778/cmajo.20180077