Patient Safety in Neurosurgical Practice: Physician and Patient Factors that Contribute to Patient Injury.
BACKGROUND
Recommendations that may help reduce adverse events outside the perioperative period are uncommon. We identified the primary factors that contributed to patient injury in neurosurgical practice both within the perioperative period and outside the perioperative period.


METHODS
Medical malpractice claims (n = 355) from The Doctors Company that were closed over 7 years were reviewed by neurosurgical medical experts. Objective neurosurgical expert analysis of the cases identified patient injuries and the primary factor that contributed to the patient injury.


RESULTS
Continued pain, nerve damage, and need for additional surgery were the most common injuries. In 145 cases (40.8%), the primary factor that contributed to patient injury occurred outside the perioperative period: assessment (evaluation and diagnosis), selection and management of therapy, and communication between the physician and patient/family. In 138 (38.9%) cases, the primary factor that contributed to patient injury occurred within the perioperative period. Surgical complication (a known risk of the procedure) was the primary factor in 99 cases (27.9%), and technical performance of surgery was the primary factor in only 39 cases (11.0%).


CONCLUSIONS
In addition to excellent surgical technique, checklists, teamwork, outcomes measurement, and regionalization of subspecialty care, improving patient safety in neurosurgical practice requires careful attention to care provided outside the perioperative period. Differential diagnosis, consideration of all relevant clinical data, active pursuit of good physician-patient relationships, and adequate monitoring of patients receiving nonsurgical treatment may also help improve patient safety in neurosurgical practice.
Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA. Electronic address: ctaylor@salud.unm.edu.
Christopher L
CL
Taylor
The Doctors Company, Columbus, Ohio, USA.
Darrell
D
Ranum
D005104:Expert Testimony; D006801:Humans; D015994:Incidence; D008318:Malpractice / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000401:mortality*; D000069471:Neurosurgeons / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000401:mortality*; D061214:Patient Safety / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D014481:United States; D014947:Wounds and Injuries / Q000401:mortality*
Adverse events; Complications; Liability; Medical error; Neurosurgery; Patient safety