Use of Clinical Practice Guidelines in Medical Malpractice Litigation

This chapter assesses theory and evidence on the efficacy of medical malpractice liability and limitations to it in improving healthcare outcomes, and identifies unresolved issues that merit further attention from scholars. First, it explores the theoretical and legal background on medical malpractice. It then turns to the available evidence by focusing on three basic areas of study: the impact of malpractice limitations on payouts and litigation, the effect of malpractice limitations on overall healthcare costs, and the effect of malpractice on two major cost drivers in the healthcare system: cardiac and obstetrics practice. It argues that limitations on liability did not and likely cannot significantly reduce healthcare costs. Finally, the chapter discusses new and important trends in the literature regarding reforms to standards of care and the role of clinical practice guidelines and communication and disclosure programs.

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Medical Malpractice Implications of Clinical Practice Guidelines

Otolaryngology ◽

10.1177/0194599817707943 ◽

2017 ◽

Vol 157 (2) ◽

pp. 175-177 ◽

Cited By ~ 3

Author(s):

Douglas S. Ruhl ◽

Gil Siegal

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Medical Malpractice

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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