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Investigation of Medical Complaint Dr. Layla Al Marzouqi Head of Clinical Governance Health Regulation Department (HRD). Medical Complaint. Expressions of dissatisfaction or concerns about a health care service made by consumers.

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Investigation of medical complaint dr layla al marzouqi head of clinical governance

Investigation of Medical Complaint Dr. Layla Al MarzouqiHead of Clinical Governance

Health Regulation Department (HRD)


Medical complaint
Medical Complaint

  • Expressions of dissatisfaction or concerns about a health care service made by consumers.

  • All complaints & concerns are included, whether they are formal written complaints, a concern expressed during discussions with a health care professional, or views expressed as part of a consumer feedback survey.


Institute of medicine in us
Institute of Medicine in US

preventable medical errors kill 98,000 /year

100,0000 excess injure preventable medical errors : sixth leading cause of death in America

Aggressive case finding may identify injuries and errors that are not documented in a patient's chart


Bureau of justice statistics
Bureau of Justice Statistics

25% of all the doctors in USA get sued / annual

50 & 65% all doctors in USA sued at least once in their career

½ adverse events occurring inpatients resulted from surgery.

Complications from drug treatment, therapeutic mishaps, and diagnostic errors were the most common non-operative events.


Investigation of medical complaint dr layla al marzouqi head of clinical governance

Despite shocking number of medical errors

  • few injured patients ever file a medical negligence lawsuit

  • fewer file frivolous claims

    epidemic of medical malpractice, not of malpractice lawsuits


Risk factors for error
Risk factors for error

  • Healthcare Complexity

  • Complicated technologies, powerful drugs

  • Intensive care

  • prolonged hospital stay adverse event increased by 6% /day in hospital

  • emergency department

    • part time doctors not trained in emergency care;

    • fluctuating demand for services, which results in uneven and sometimes abbreviated care;

    • limited time available to arrive at a definitive diagnosis;

    • emergency department is the point of entry for acutely ill patients


Risk factors for error1
Risk factors for error

  • System and Process Design

    Problem in medical errors is not bad people in health care—it is that good people are working in bad systems that need to be made safer

  • Poor communication/documentation

  • Disconnected reporting systems within a hospital: fragmented systems in which numerous hand-offs of patients results in lack of coordination and errors

  • Cost-cutting measures/staff shortage


Risk factors for error2
Risk factors for error

JCIA report :

  • root cause >1/2 the serious adverse events in accredited hospitals was poor communication

  • Other leading causes :

    • inadequate assessment of the patient's condition

    • poor leadership or training


Risk factors for error3
Risk factors for error

  • Competency, Education, and Training

    Variations in healthcare provider training & experience

  • Failure to acknowledge the prevalence and seriousness of medical errors

  • July effect


Risk factors for error4
Risk factors for error

Human Factors

Sleep deprivation

  • Fatigue

  • Depression and burnout

  • Diverse patients

    • Age -64

    • patient's underlying illnesses

  • Unfamiliar settings

  • time pressures

  • Complications increase as patient to nurse staffing ratio increases


  • Preventing medical errors will
    Preventing medical errors will

    lower health care costs

    reduce doctors’ insurance premiums

    protect the health and well-being of patients & reduce hospital stay




    Investigation of medical complaint dr layla al marzouqi head of clinical governance

    How to conduct provided without error

    an investigation


    Objective
    Objective provided without error

    To protect public health & safety by resolving investigation and prosecuting complaints about health care.


    Types of complaint
    Types of complaint provided without error

    • Health complaints

    • Non health complaints

      • Insurance

      • Criminal

      • Financial

      • Behavior



    Degree severity of health complaints
    Degree/Severity of health complaints provided without error

    Major

    Moderate

    Minor


    Severity of complaints
    Severity of complaints provided without error

    Minor complaints

    Complaints that can be resolved based on the assessment findings

    Example: Patients with no injury or increased length of stay


    Severity of complaints1
    Severity of complaints provided without error

    Moderate complaints

    Complaints require only assessment & might need to be investigated based on assessment findings.

    Example: Increased length of stay as a result of incident, Surgical intervention required as a result of an incident.


    Severity of complaints2
    Severity of complaints provided without error

    Major complaints

    Complaints that need to be investigated immediately by an investigation committee without assessment.

    Example: Procedure involving wrong patient or body, part, Medication error leading to death.


    Investigation
    Investigation provided without error

    Major Complaint


    Clinical governance office
    Clinical Governance Office provided without error

    Decision to investigate

    Select investigation committee member ( private/public)

    Facilitate their work

    Conclude any member

    Review investigation report


    Investigation committee
    Investigation committee provided without error

    Each case will consists of following committee members from the same speciality of the case:

    • One Chairperson

    • At least 2 Health Professionals registered and licensed

    • Legal representative will be consulted upon need


    Chairperson
    Chairperson provided without error

    Decide on the meeting and send invitation

    Lead the meeting / Distribute the role

    Prepare investigation report

    Sign all document

    Interview is singed by doctors & complainant

    Available to discuss/clarify out

    Translation


    Chair person member
    Chair Person/Member provided without error

    Sign conflict of interest and confidentiality form

    Review files

    Attend all meetings

    Respect/ introduction ( name. complaint)

    Conduct Interviews- venue, time, date , attendee

    Investigate medical aspect

    No result to be given to complainant

    Not interfere with each other decision

    Ask question equally

    Disclosure to third party


    Chair person member1
    Chair Person/Member provided without error

    Consult other specialty

    If compliant or healthcare professionals is not contactable

    Malpractice definition-law

    Reasons for decision

    Mobiles not allowed

    Recorder use

    Court

    Sign the report


    Old definition
    Old definition provided without error

    Negligence

    • Failure to act with prudence a reasonable person with similar training & experience would exercise under same circumstances.

    • Includes medical error in diagnosis, treatment or illness management

      Malpractice

    • When negligence act or omission by a doctor or other medical professional results in damage or harm to a patient.

    • Act or omission by a healthcare provider which deviates from accepted standards of practice & causes injury to the patient


    New definition malpractice
    New Definition provided without error Malpractice

    Malpractice

    Is an error occurs due to

    Unfamiliarity of the practitioner with technical aspects which each practitioner assumed to be familiar with

    Negligence

    Paying insufficient efforts


    Not malpractice
    Not Malpractice provided without error

    The following shall not be considered medical liability, if:

    damage was sustained due to the action of the patient

    physician followed certain medical method in treatment

    medical side effect & complications know in medical practice



    Appeal
    Appeal HRD

    Appeal occurs when the complainant or treating doctor is not satisfied with the outcome of the complaint

    Appeals will be forwarded to higher authority for further action

    Appeal decision not the disciplinary action


    Criteria appeal
    Criteria Appeal HRD

    Appeal should fulfill the following conditions;

    Whiting 15 days of receiving the final result of the investigation

    New evidence

    Either

    appoints appeal committee members-three members at least

    Reject the appeal


    Criteria appeal1
    Criteria Appeal HRD

    Decisions shall be final

    One appeal per case


    Writing an appeal
    Writing an appeal HRD

    Be professional

    More evidence

    Disciplinary action implemented after 15 days

    How effective ?

    Rejected / submission of the license/ assessment

    Assessment panel

    Decision of assessment panel ( same post/ privilege/ downgrade/ under supervision)

    Return the license


    Applying for reassessment
    Applying for reassessment HRD

    Sheryan

    Assessment icon

    Schedule assessment date

    On line assessment ( 10 specialties) /interview

    Fee


    Contact us
    Contact Us HRD

    Business village Building B third floor Office number 333-335

    04-5022956/53

    cg@dha.gov.ae

    www.dha.gov.ae