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Patterns of Technical Error Among Surgical Malpractice Claims

Atul Gawande and his co-authors discover some surprising results: most technical errors are in routine operations with experienced surgeons…to prevent the largest number of injuries and make greatest improvements in surgical safety, further research should focus on designing targeted interventions to improve decision-making and performance in routine operations for high-risk patients and circumstances.

Abstract

Most technical errors occur in routine operations with experienced surgeons, under conditions of increased patient complexity or systems failure. Commonly recommended interventions, including restricting high-complexity operations to experienced surgeons, additional training for inexperienced surgeons, and stricter supervision of trainees, are likely to address only a minority of technical errors. Surgical safety research should instead focus on improving decision-making and performance in routine operations for complex patients and circumstances.

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In summary, we have used surgical malpractice claims data to inform priorities for improving surgical safety. We find that technical errors resulting in serious injury to surgical patients occur most often in routine operations conducted by experienced surgeons, but with complex patients and/or circumstances. Volume- or experience-based restrictions on privileging for high-complexity operations, expanded training for young surgeons, and limitations on the practice of surgical residents each address only a minority of the errors we observed. Although these interventions may have broad effect in combination, our data suggest that to prevent the largest number of injuries and make greatest improvements in surgical safety, further research should focus on designing targeted interventions to improve decision-making and performance in routine operations for high-risk patients and circumstances. 

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