Medical Legal Concerns And Risk Management

Question 1

Why is there controversy on the progress and outcome of labor and effect on the fetus

Answer 1

Increase instrument usage
Increase CS deliveries
Prolonged labor
Fetal occiput posterior presentation

Question 2

Why is there controversy behind epidurals

Answer 2

Motor blockade may prevent mother from pushing
Higher incidence of occiput posterior position of fetus
Decreased threshold for instrument assisted deliveries
Residents perform them

Question 3

Complications from regional

Answer 3

Maternal fever
Backpain
Neuro sequelae
PDPH
Neonatal effects
Hypotension
Inadequate analgesia
Infection/hematoma

Question 4

Maternal fever is caused by

Answer 4

Longer duration of labor with epidural
Epidural without epi has no higher incidence
Sepsis of infants is low

Question 5

Back pain is associated with

Answer 5

Greater weight and short statue
Not with epidural attempts
Not related to neuraxial anesthesia
Continuation of antepartum pain

Question 6

Resolution in cases of epidural abscess/hematoma

Answer 6

Monitor, early diagnosis, prompt treatment

Question 7

Regional block considered causative until proven other with what complications

Answer 7

Neurologic

Question 8

Inversely proportional to provider experience

Answer 8

PDPH

Question 9

T of F all HAs are not PDPH

Answer 9

T

Question 10

Spinal needle design and size affects which complication

Answer 10

PDPH

Question 11

Caused by epidural or labor pain

causes occiput posterior which causes patient to request epidural

Answer 11

Neonatal effects

Question 12

Most common effect of spinal for CS

Treat early and aggressively

Answer 12

Hypotension

Defined as SBP <100

Question 13

Differential diagnoses for PDPH

Answer 13

Nonspecific
Migraine
Meningitis
Pregnancy induced HTn associated with HA
Cerebral tumor
Subarachnoid hemorrhage (HELLP)
Subdural hematoma
Cerebral vein thrombosis

Question 14

Recognizing what resulted in the increased use of regional for elective and emergency CS
And has led to a decrease in maternal mortality

Answer 14

That regional is preferable even when fetus status is not reassuring

Question 15

Why are there challenges for litigation with GA

Answer 15

Awareness and recall risk
Avoidance of sedatives as premeds
Low concentration of IAs
Use of muscle relaxants
Reduction of dose of anesthetics
Partial neuraxial blockade requiring conversion to GA
Wrong assumption that baseline sympathetic tone is responsible for tachycardia

Question 16

Leading causes of maternal death

Answer 16

Unsafe abortion
Cardiac conditions
Infections
Hemorrhage embolism
PIH
Complications from delivery

Question 17

What contributes to upward trend of MMR

Answer 17

Inconsistent OB practice
Increasing antenatal chronic conditions such as HTN, DM, obesity
Lack of good data and related analysis outcomes

Question 18

What anesthesia is associated with the highest rate of maternal mortality

Answer 18

GA for CS from failed intubation or aspiration

GA higher risk with OB pt

Question 19

Delayed recognition, delayed diagnosis, and treatment of problems lead to poor outcomes

Answer 19

Theme 1 of OB closed claims

Question 20

Failed communication could lead to delay in appropriate treatment, multiple providers, treating the same problem or no on treating the problem leading to a poor outcome

Answer 20

Theme 2

Question 21

Conflicting documentation may lead to poor outcomes and or anesthesia provider being named in claim; good documentation demonstrates appropriate care given and/or may keep anesthesia provider from being named in claim

Answer 21

Theme 3

Question 22

Unexpected or unrecognized hemorrhage may lead to death or brain damage

Answer 22

Theme 4

Question 23

Lack of vigilance may lead to permanent deficits or brain death

Answer 23

Theme 5

Question 24

Major complications related to anesthesia

Answer 24

Aspiration pneumonitis
Maternal death or brain damage - problem with difficult intubation and pulmonary aspiration
Neonatal brain damage or death
Maternal nerve injury

Question 25

Claims for minor injuries such as these are on the rise

Answer 25

HA, back pain, pain during anesthesia, emotional distress

Question 26

How to establish malpractice

Answer 26

There must be duty, breach, injury, proximate cause

Question 27

Must be shown that a duty to provide care existed

Answer 27

Duty

Question 28

HCP failed to meet his or her duty to provide reasonable care

Answer 28

Breach

Question 29

Patient experienced injury that resulted in damages

Answer 29

Injury

Question 30

Negligence of HCP caused patient’s injury

Answer 30

Proximate causes

Question 31

How can anesthesia avoid litigation

Answer 31

Communication Documentation Vigilance

Question 32

The leading cause of errors and patient harm

Answer 32

Communication

Question 33

How to improve communication

Answer 33

Team huddles Multidisciplinary rounds Debriefings Structured method for passage of critical information

Question 34

How does miscommunication play a factor into informed consent

Answer 34

Specific patient request ignored | Patient not informed of specific complication

Question 35

Explicitly mention and document

Answer 35

Entire range of risks Educate patient about unpredictable course of events and possible complications Alternative treatment discussed

Question 36

When are consents best done

Answer 36

In advance of labor

Question 37

Remember to get written consent for labor epidurals

Answer 37

T

Question 38

How does documentation lead to poor litigation outcomes

Answer 38

Conflicting docs

Question 39

The act of being alert and watchful for potential danger of difficulties

Answer 39

Vigilance

Question 40

Continual patient assessment, review of surgical field, anticipation, preparedness for potential adverse events, respond in timely manner to changes

Answer 40

Vigilance