Current Trends and Predictors of Case Outcomes for Malpractice in Colonoscopy in the United States

The Government as Plaintiff: An Analysis of Medical Litigation Against Healthcare Providers in the Eastern Province of the Kingdom of Saudi Arabia

OBJECTIVES

The Saudi healthcare and medicolegal systems have seen several developments to improve quality of services and ensure patient safety. However, violation claims have seen an upward trend in the past few years. Several studies have analyzed medical litigation to better understand violations within healthcare sectors and address them accordingly. Such studies have focused extensively on medical litigations filed by patients against healthcare providers, overlooking other plaintiffs, such as governments. In this study, we examined violation claims filed by governmental entities against healthcare providers in the Eastern Province of the Kingdom of Saudi Arabia.

METHODS

From 2016 to 2019, 718 healthcare providers were involved in violation claims that were referred to the Medical Offenses Committee. Two logistic regression analyses were performed to identify significant predictors of receiving a guilty verdict and the verdict type (for guilty verdicts), given defendant-related factors.

RESULTS

Eighty-two percent of healthcare providers received a guilty verdict. Guilty verdicts were prevalent among non-Saudis and healthcare providers in the private sector. Healthcare providers working in the private sector were significantly more likely to receive a guilty verdict than healthcare providers working in the public sector. Nurses were significantly less likely to receive a guilty verdict than physicians. Being involved in violation claims with 5 or more codefendants decreased the likelihood of receiving a guilty verdict. In addition, non-Saudis being involved in violation claims with multiple defendants, working in the private sector, and working in pharmacies and medical complexes were significant predictors of the verdict type.

CONCLUSIONS

Results of the study extend the extant literature by analyzing medical litigation including plaintiffs other than patients. In addition, the study introduces implications for the government and policymakers as well as areas for future research The study's findings emphasized the importance of employment sector and number of defendants as significant predictors of violation claims' verdicts. Policymakers should take into consideration significant predictors to ensure healthcare providers' compliance with respective rules and regulations. Tailored attention toward these predictors could minimize the prevalence of medical violation claims, ensure patient safety, and avoid associated negative consequences.

Medical malpractice and gastrointestinal endoscopy

PURPOSE OF REVIEW

Medical liability is a perennial issue that most physicians will face at some point in their careers. Gastroenterologists routinely perform endoscopic procedures to aid in the diagnosis and treatment of their patients. Advances in endoscopic techniques and technology have accelerated movement of the field into a more surgical realm. These developments warrant consideration of pitfalls that may expose gastroenterologists to liability. This review will explore trends in malpractice facing gastroenterologists and offer strategies to deliver high quality and safe patient care.

RECENT FINDINGS

Despite being a procedure-oriented subspeciality, only a minority of malpractice claims against gastroenterologists are related to procedures. Diagnostic error is among the most prevalent reason for lawsuits. The consequences of malpractice are costly due litigation and indemnity as well as the increase in defensive medical practice. Improving diagnostic quality, optimizing informed consent, and enhancing patient-physician communication are important elements of risk mitigation.

SUMMARY

Understanding the important role that diagnosis plays in medical liability allows physicians to better evaluate risk and apply deliberate decision-making in order to practice confidently.

VOLUMETRIC CAPNOGRAPHY FOR RESPIRATORY MONITORING OF PATIENTS DURING ROUTINE COLONOSCOPY WITH ROOM-AIR AND CARBON DIOXIDE INSUFFLATION

BACKGROUND

Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy.

OBJECTIVE

This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy.

METHODS

In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale.

RESULTS

The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05).

CONCLUSION

In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.