Laparoscopic procedures may have led to increased recognition and quantification of technical errors. The identification of errors is just the first initial step in the improvement of patient care. However, healthcare systems need to establish an environment that fosters the discussion of errors while focusing on systemic changes to prevent future occurrences without assigning blame to the providers involved. Implementing systemic changes within a healthcare system is a complex process. One easy way to ensure compliance nationwide is by managing adverse events and errors in the hospital setting. Healthcare systems need to commit time, infrastructure, and other resources to effectively make viable changes over time to address the issue of surgical errors and adverse events in a sustainable manner.
Over the past few decades, patient safety has become more critical for providers and healthcare institutions. It is now a ubiquitous marker for quality patient care. The increased focus on medical safety is due to our patients' rapidly increasing medical complexity. Medically complex cases have an increased risk for adverse events and increased potential for patient safety incidents. Note that patient safety incidents can lead to a chiasm between patient expectations and the perception of the quality of patient care—for example, a patient who presents with a large middle cerebral artery territory infarct with multiple comorbidities. The patient receives tissue plasminogen activator (tPA) to treat the recent stroke. A few days later, the patient developed hemorrhagic conversion of the previously noted large ischemic infarct. The patient may perceive this as an iatrogenic effect rather than a complication sometimes seen in patients with foci of the ischemic infarct. The wider the chasm between the patient's expectations and the perceived quality of care, the more dissatisfaction the patient may experience. Dissatisfaction may eventually lead to increased insurance claims filed for medical negligence. Medical negligence claims are more common in surgery cases, specifically in orthopedic surgery, trauma surgery, and obstetrics and gynecology (Vicente-Guijarro et al., 2021).
Adverse events or medical errors cause negative consequences for multiple parties—specifically, the patients directly affected as the primary victims. The healthcare providers who suffer the shame, guilt and mental anguish of being involved in surgical errors or surgical cases with adverse events can be considered second victims. The third victims are the healthcare institutions that have to address potential damages to their reputations and/or face the financial ramifications of the surgical error or adverse events (Vicente-Guijarro et al., 2021).
Financial ramifications can be indirectly quantified by the compensation claims filed with the insurance agencies. Adverse events can increase the cost of surgical care in several ways. First, the adverse event may require additional procedures or medications to treat the complications associated with the adverse event. In addition, the clinicians involved in the surgical error or adverse event may start practicing defensive medicine, which could lead to the performance of unnecessary clinical or surgical tests as an attempt to prevent medical litigation. Thirdly, the cost of paid malpractice claims usually borne by the healthcare institution could lead to increased insurance rates over time (Vicente-Guijarro et al., 2021).
Over the past few years, patient safety research has demonstrated that mortality is not the most accurate measure of documenting preventable patient harm. Other measures of preventable harm should include diagnostic errors, decreased quality of life, patient morbidity, and loss of dignity. As such, the focus on patient safety is no longer only centered on hospitals. Instead, it has been adjusted to include all healthcare settings, including inpatient, outpatient, and home health settings.
A common problem encountered when addressing medical or surgical errors in health care systems is the problem of many hands, which makes it difficult to hold one person or department responsible for all errors or adverse events. Causes for errors are multifaceted and need to be thoroughly investigated to identify the actual problem and, subsequently, the solution.
Defensive medicine is all medical care provided by physicians and other clinical providers with the primary goal of preventing the risk of litigation. These redundant defensive medicine practices may increase healthcare expenditure (Garattini and Padula, 2020). Defensive medicine practices can be divided into two types: positive and negative. Positive defensive medicine practices are characterized by the provider ordering repetitive or unnecessary tests, procedures, interventions, and referrals. Negative defensive medicine practices are characterized by the provider refusing to take high-risk patients or avoiding high-risk procedures. Defensive medicine practices can also include providers feeling like lower–tiered clinicians amongst other providers because of medical or surgical errors.