The impact of the ASA Closed Claims Project was examined at the ASA Annual Meeting on October 20 in a panel session of the Committee on Professional Liability with the Director of the ASA Closed Claims Project.
Panel participants included Jeffrey B. Cooper, Ph.D. (Director of Anesthesia Technology at Massachusetts General Hospital), Ellison C. Pierce, Jr., M.D. (President of the Anesthesia Patient Safety Foundation), Mr. Mark Wood (Director of Risk Management Services at St. Paul Fire and Marine Insurance Company), and Robert A. Caplan, M.D. (Chairman of the ASA Committee on Patient Safety and Risk Management and Co-Director of the ASA Closed Claims Project). Dr. Fred Cheney, the other Co-Director of the ASA Closed Claims Project, reviewed the history and present status of the Closed Claims Project. The feasibility of closed claims analysis was first demonstrated by Dr. Richard Ward in the mid-1980s. Since that time, the Closed Claims Project has grown vigorously.
At present, the project database contains nearly 3,000 claims, collected from the closed files of approximately 30 U.S. insurance carriers. The primary work force of the project is a dedicated team of practicing anesthesiologists who make a voluntary donation of time and expertise in order to review and analyze closed claims. Dr. Cooper provided a critical appraisal of the project methods, emphasizing the merits of sentinel event analysis and its successful application in this area of research. He also reviewed the limitations imposed by the retrospective nature of Closed Claims data, and the potential for bias and distortion by original participants and later reviewers. Dr. Pierce described the positive impact of the Closed Claim. Project on patient safety, highlighting the pivotal role that claims data have played in the formulation of monitoring standards. Mr. Wood used the claims experience of the St. Paul Company to illustrate the linkage between improved intraoperative monitoring and the reduction in hypoxic injuries. Dr. Caplan presented a brief survey of the scientific study of peer review, another area of focus for the Closed Claims Project. Preliminary research indicates that anesthesiologists show significant agreement on basic issues of peer review, but the strength of agreement is modest and physician judgments are strongly biased by outcome. Explicit tools for case review may improve the validity and reliability of peer review. Dr. Cheney concluded the panel session with a glimpse into the future. He predicted that claims for inadequate ventilation, esophageal intubation, and injuries arising from difficult intubation would all show a considerable decline, largely as the result of pulse oximetry, end-tidal capnography, and improved strategies for difficult airway management. He also predicted that peripheral nerve injuries would persist, unless research efforts yield a better understanding of the basic anesthetic injuries.
Dr. Caplan, Mason Clinic, Seattle, WA, chairman the ASA Committee on Patient Safety and risk Management, is on the Executive Committee of the APSF.