Responsabilidad profesional y seguridad clínica en el tromboembolismo venoso

Abstract

Introduction: The presence of venous thromboembolism, which arises suddenly either during a disease or the postoperative period of surgery, stand for a clinical risk, as well as a medical-legal risk. In fact, the claims related to Venous Thromboembolism (VTE) and the medical professional responsibility are closely related to the correct use of prophylaxis. Among medical professionals there is a poor knowledge about the likelihood for their patients to go through a VTE (with or without prophylaxis) after a specific treatment. Hypothesis And Objectives: The main hypothesis of this study is that the correct adherence to the clinical practice guidelines exempts to the professional from medical responsibility. The objective is to analyse all the complaints related to VTE registered in the Professional Liability Department of the Medical College of Barcelona. This will allow us to know the profile of the medical or surgical specialties in greater risk for claim, as well as those pathologies linked to claim due to VTE. To know the variables affecting and influencing the claims under study. To analyse the grade of adherence of the clinicians to the clinical practice guidelines for antithrombotic prophylaxis. It will allow a better knowledge about the risk of claiming related to VTE and its derived consequences, helping to the improve of the medical practice and clinical safety. Material And Methods: The sample was all the cases registered at the Council of Medical Colleges of Catalonia from 1986 to 2014, deriving into judicial and extrajudicial claims because of alleged medical negligence following venous thromboembolism. A total of 100 cases were analysed. The data was extracted with electronic support and the review of the files was performed on-site, individually and fully detailed. Statistical analysis was performed in two phases; first one, a descriptive analysis of the variables, followed by the study through a bivariate and multivariable analysis of possible associations with the main variable (responsibility). In both analyses a descriptive cross-sectional design was followed using the SPSS statistical package. Results: From 1986 to 2014, a total of 100 medical claims related to VTE were registered, 62 were related to pulmonary thromboembolism, 8 of them with deep venous thrombosis (DVT) associated, 30 cases of DVT and 8 cases of superficial venous thrombosis. In 24 cases the medical professional responsibility was demonstrated. The specialty with more complaints was Traumatology. According to the chief reason for complaint, 43 cases occurred in low-risk patients with no prophylaxis prescribed but VTE was present, 25 cases of correct prophylaxis but with VTE, 18 cases with no prophylaxis administered and 9 cases with prophylaxis not well managed. Professionals acted according the guidelines in 73 of the cases, while in 25 there was no correct adherence to the guidelines. In the statistical analysis, the variable liability was significantly associated with non-adherence to the guidelines, as well as the absence of the use of prophylaxis (p <0.05). Conclusion: Non-adherence to the guidelines along with the non-administration of prophylactic heparin are the factors mainly related to medical professional responsibility in cases of venous thromboembolism. However, the correct adherence to the guidelines does not exempt to the physician from liability in case of VTE. Finally, the individualized prophylaxis and not the application of the protocols makes safe to the clinical practice and at the same time avoid medical professional responsibility.

Date of Award	26 Jun 2017
Original language	Spanish
Awarding Institution	Germans Trias i Pujol University Hospital
Supervisor	Enric Roche Rebollo (Director), Jose Arimany Manso (Director), Jaume Fernández-Llamazares Rodríguez (Tutor) & Manuel Monreal Bosch (Director)