A pilot study of closed compensation claims held by the Medical Misadventure Unit, Accident Rehabilitation and Compensation Insurance Corporation

Abstract

This thesis reports the findings of a pilot study which is part of a larger study, the Auckland Regional Pilot Audit Study (ARPAS), being undertaken by the Auckland Medical School, which will measure and describe the prevalence of AEs in the Auckland geographical area. This study, based on compensation claims, was a parallel study and therefore the same approach was taken for methodological reasons and comparative purposes. The objective of this compensation study was to understand some aspects of the relationship between claim compensation costs and the preventability of an adverse event (AE) or medical misadventure. Another objective was to collect information that could be used in ACC prevention strategies. The focus of the study was closed compensation claims held by the Medical Misadventure Unit of the Accident Rehabilitation and Compensation Insurance Corporation (ACC). The Medical Misadventure Unit was established in 1992, to manage all medical misadventure claims occurring in New Zealand. This study is unique for several reasons as it reports on compensation claims: 1. That are managed under a no fault scheme. 2. That include a wide range of medical environments. The study included two hundred and sixty eight compensation claims, both declined and accepted outcomes, and these claims covered a wide range of medical environments. For this reason, this study was unusual, as most of the previous studies conducted into adverse events tended to be hospital based. This was a pilot study which was limited to Medical Misadventure claims originating in the Auckland area. The features of the project were to examine the injuries caused by iatrogenic injury and to rate the preventability of these accidents. Descriptive information and causation data were also collected to help the ACC focus on their injury prevention initiatives. The methodology utilised was the Record Review Process, based on previous investigations successfully completed in the U.S.A and Australia. In essence this process used trained Clinical Reviewers who examine each claim file and identify any possible adverse event. This pilot compensation study has implications for quality management and injury prevention strategies. Although this was a small study and some of the objective could not be realised, the study pinpointed areas where further investigations should be directed. There are locations or specialties where more adverse events occur. The findings pertaining to preventability are: System errors had the highest preventability rating: 81% were deemed to be preventable. 38.5% of all the General Practice claims were judged to be highly preventable. 29.7% of all the claims were judged to be highly preventable. There was a relationship between cost and preventability. The highest costing claims have the lowest preventability. Other findings were: There were 228 adverse events recorded for 11 procedures. 39.9% of those accidents were related to operative procedures. Only 172 adverse events were coded to a procedure. 41.9% of them occurred in the operating theatre. The Clinical Reviewers found no adverse event present in 21.5% of the compensation claims. 19.4% of the claimants had suffered a permanent disability. (This included two fatal claims.) Of interest to those managing health systems was that the adverse events resulted in the claimant spending, on average, an extra seven days in hospital. The ACC will be able to integrate the following findings into their injury prevention strategies: The Clinical Reviewers thought 30.8% of the iatrogenic injuries were caused by the health professional failing to take adequate precautions. About a quarter of all the medical accidents could be prevented through educative initiatives.