Investigating errors in medical imaging: medical malpractice cases in Finland

Objective The objectives of the study were to survey patient injury claims concerning medical imaging in Finland in 1991–2017, and to investigate the nature of the incidents, the number of claims, the reasons for the claims, and the decisions made concerning the claims. Materials and methods The research material consisted of patient claims concerning imaging, sent to the Finnish Patient Insurance Centre (PVK). The data contained information on injury dates, the examination code, the decision code, the description of the injury, and the medical grounds for decisions. Results The number of claims included in the study was 1054, and the average number per year was 87. The most common cause was delayed diagnosis (404 claims, 38.3%). Most of the claims concerned mammography (314, 29.8%), radiography (170, 16.1%), and MRI (162, 15.4%). According to the decisions made by the PVK, there were no delays in 54.6% of the examinations for which claims were made. About 30% of all patient claims received compensation, the most typical reason being medical malpractice (27.7%), followed by excessive injuries and injuries caused by infections, accidents and equipment (2.7%). Conclusion Patient injury in imaging examinations and interventions cannot be completely prevented. However, injury data are an important source of information for health care. By analysing claims, we can prevent harm, increase the quality of care, and improve patient safety in medical imaging.

Experiences of Navigator, a Finnish patient-segmentation service, in primary care: A mixed-methods study

Aging and multimorbid populations burden health services worldwide. Segmenting patients with similar health service needs into different groups and guiding care providers to tailor services to these groups could reduce this burden. Methods of patient segmentation have been based on, e.g., databases. However, the Finnish patient-segmentation innovation Navigator (Suuntima) considers patients’ perspectives on their coping in everyday life, as well as professionals’ views of the patients’ state of health. The segmentation is based on questions. The resulting care pathway related to the group helps professionals to coordinate patients’ health care and patients to utilize appropriate services. This first part of Navigator’s validation study evaluates its feasibility and content and face validity. We assess the web-service’s user experiences at nurses’ appointments with diabetic patients, time consumption, and Navigator’s question relevance, comprehensiveness, and comprehensibility. This mixed-methods study uses user experience questionnaires for both patients and professionals, and semi-structured focus-group interviews for professionals. We used descriptive statistics in the quantitative data analysis of the questionnaire study and thematic analysis to identify the codes and themes in the interview data. All 304 Navigator queries were completed at appointments. Most patients found Navigator easy to use. It helped in considering their situation better and from new perspectives. Most patients did not find it too time-consuming. Most professionals found it easy to use and suitable for appointments and patient segmentation. The questions were easy and unambiguous, and they assisted in discussing new or sensitive issues. Most queries were completed in less than 19 mins and less time was used if the patient was assigned to the nurse. Thematic analysis raised five main themes: 1) Well-functioning web-service, 2) Stimulus for conversation and action, 3) Rationale to complete Navigator with a professional, 4) Training and experience ease the use of Navigator, and 5) Navigator's room for improvement. Subthemes were identified for three main themes. We consider Navigator’s feasibility and face validity to be favorable. We suggest user instructions and the clarification of concepts to support the questions’ comprehensibility. Some patients may benefit from a nurse’s presence when responding to Navigator’s questions.

Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017

Objectives This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI). Methods PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified. Results Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal. Conclusions PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common.