What We Learn From Anesthesia Malpractice Claims

December 5, 2023
Improper management of anesthesia leads to patient harm

A 61-year-old man with a recurrent retinal tear in his left eye saw his eye surgeon, who recommended repeat surgery to repair the retina. Near the end of the surgical procedure, the patient coughed against the endotracheal tube, struck his left eye on the surgical microscope, and sustained an intraocular hemorrhage and eye damage, which resulted in the near total loss of sight in his left eye. The man also sustained disfigurement of his left eye and had to undergo enucleation and replacement of the eye.

The man filed a malpractice claim against the anesthesiologist, alleging insufficient anesthesia during the procedure, which allowed him to cough while on the operative table. The anesthesia documentation did not mention the harm event, although the event was noted in the operative note by the surgeon.

The experts who reviewed the case were critical of the care the anesthesiologist provided, indicating the anesthesia dosages were low. The case was settled with a payment made to the man on behalf of the anesthesiologist.

Top allegations in anesthesia malpractice claims

In an analysis of our malpractice claims, allegations triggering anesthesia cases are #6 in both occurrence and cost. The top allegations involved in anesthesia claims include improper management of the patient and improper performance of anesthesia. Tooth damage due to intubation or extubation represents 34% of claims but accounts for only 1% of costs.

Top Anesthesia Allegations

Top Contributing Factors

All graphs represent former Constellation, Inc. malpractice claims reviewed as of 12/31/2020

Top contributing factors involved in anesthesia claims

Contributing factors are the factors that lead to patient harm and are amenable to risk mitigation strategies. A single harm event can, and usually does, involve multiple contributing factors. The number one contributing factor in anesthesia claims is technical skill issues, including known procedural risks. With over two-thirds of claims involving technical skill factors, having effective informed consent discussions with patients using a patient-centered, shared decision-making approach can reduce unrealistic or unmet expectations from the patient. A robust credentialing and privileging process, as well as a peer review process, can help ensure the technical skill and competency of anesthesia clinicians.

Strategies to mitigate anesthesia harm events

  • Obtain a detailed medical history, including allergies, medications and previous experiences with anesthesia.
  • Perform a comprehensive physical examination to identify any potential risks or contraindications, including assessing the patient’s airway, breathing and circulation to determine the most suitable anesthesia plan.
  • Have a comprehensive discussion with the patient about risks (including dental risks), complications and benefits of the anesthesia plan, and what to expect postoperatively. Encourage patients to disclose all relevant information about their health that could impact the anesthesia plan.
  • Document thorough risk evaluations and informed consent discussions in the patient medical record.
  • Ensure clear and open communication among the anesthesia team, surgical team and other healthcare providers involved in the patient’s care. Discuss any concerns or specific patient conditions that may impact the anesthesia plan.
  • Apply a failure mode and effects analysis (FMEA) to anesthesia care processes (e.g., pre-anesthesia evaluation, procedure selection, airway management, medication management) to identify potential adverse outcomes and to improve care.
  • Ensure anesthesia clinician technical skill and competency with a robust credentialing and privileging process, as well as a peer review process. Verify and validate clinician privileges before each procedure.
  • Be prepared for emergencies with well-defined protocols and access to necessary medications and equipment. Conduct regular drills to practice responding to anesthesia-related emergencies.
Risk reports

Our risk reports analyze malpractice claim data on a variety of topics and specialties, including anesthesia. Each risk report shares insights to help reduce harm events and malpractice claims. Download the Anesthesia Risk Report.  

Are you a client? Sign in to MyAccount to access exclusive client versions of our risk reports. The expanded risk reports share actionable insights and strategies you can utilize to help reduce harm events and malpractice claims. After you sign in to MyAccount, follow Risk Resources > Tools & Resources > Publications > Risk Reports. You also have access to a host of Bundled Solutions (in Risk Resources) that cover a wide variety of topics to assist you in your risk mitigation efforts.

Curi’s risk mitigation resources and guidance are offered for educational and informational purposes only. This information is not medical or legal advice, does not replace independent professional judgment, does not constitute an endorsement of any kind, should not be deemed authoritative, and does not establish a standard of care in clinical settings or in courts of law. If you need legal advice, you should consult your independent/corporate counsel. We have found that using risk mitigation efforts can reduce malpractice risk; however, we do not make any guarantees that following these risk recommendations will prevent a complaint, claim, or suit from occurring, or mitigate the outcome(s) associated with any of them.

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