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Lessons learned from examination of Canadian medico-legal cases related to interventional therapies for chronic pain management

Leçons tirées de l’examen des cas médico-légaux canadiens liés aux thérapies interventionnelles pour la prise en charge de la douleur chronique

  • Reports of Original Investigations
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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Chronic pain is a common condition affecting almost one in five Canadians. One of the methods used to treat chronic pain is injection therapies. While they are considered relatively safe procedures, they do carry inherent risk that can result in adverse events. Our goal was to investigate these patient safety events to identify themes that could be used to shape practice guidelines and standards and improve patient safety.

Methods

We looked at closed civil legal actions and regulatory college complaints associated with injection therapies for chronic pain in the Canadian Medical Protection Association database from 2015 to 2019. Injury was defined as that arising from, or associated with, plans or actions taken during the provision of health care, rather than an underlying disease or injury.

Results

Of the 91 cases identified, the most common reported complications were neurologic-related symptoms, injury, and infection. Fifty-eight percent (53/91) of patients experienced health care-related harm that had a negative effect on their health or quality of life. Peer experts were critical of the clinical care provided in 74% (67/91) of the cases. Provider-related (60%, 40/67), team-related (75%, 50/67), and system-related factors (21%, 14/67) were identified as contributing factors in these cases. Common examples of provider-related factors were deficiencies in clinical decision-making (48%, 19/40), failure to follow established procedures (43%, 17/40), and situational awareness (38%, 15/40). Common examples of team-related factors were deficiencies in medical record keeping (80%, 40/50) and communication breakdowns (56%, 28/50). All system-related factors were related to inadequate office procedures.

Conclusion

We recommend that clinicians conduct appropriate physical examinations, keep up-to-date with clinical standards, and ensure their documentation reflects their assessment, the patient’s condition, and the treatment rationale.

Résumé

Objectif

La douleur chronique est une affection courante qui touche près d’une personne sur cinq au Canada. Les traitements par injections constituent l’une des méthodes utilisées pour traiter la douleur chronique. Bien que ces thérapies soient considérées comme des interventions relativement sécuritaires, elles comportent des risques inhérents qui peuvent entraîner des événements indésirables. Notre objectif était d’examiner ces événements liés à la sécurité des patient·es afin de cerner les thèmes qui pourraient être utilisés pour façonner les lignes directrices et les normes de pratique et améliorer la sécurité des patient·es.

Méthode

Nous avons examiné les poursuites civiles fermées et les plaintes aux ordres de réglementation associées aux traitements par injection pour la douleur chronique dans la base de données de l’Association canadienne de protection médicale entre 2015 et 2019. Était considérée comme blessure toute lésion découlant de ou associée à des plans mis en place ou des mesures prises pendant la prestation de soins de santé, plutôt que comme une maladie ou une blessure sous-jacente.

Résultats

Sur les 91 cas identifiés, les complications les plus fréquemment signalées étaient des symptômes, des blessures et des infections neurologiques. Cinquante-huit pour cent (53/91) des patient·es ont subi des préjudices liés aux soins de santé qui ont eu un effet négatif sur leur santé ou leur qualité de vie. Les expert·es ont critiqué les soins cliniques fournis dans 74 % (67/91) des cas. Les facteurs liés aux prestataires (60 %, 40/67), à l’équipe (75 %, 50/67) et au système (21 %, 14/67) ont été identifiés comme des facteurs contributifs dans ces cas. Les exemples courants de facteurs liés aux prestataires comportaient les lacunes dans la prise de décision clinique (48 %, 19/40), le non-respect des procédures établies (43 %, 17/40) et la conscience situationnelle (38 %, 15/40). Les lacunes dans la tenue des dossiers médicaux (80 %, 40/50) et les problèmes de communication (56 %, 28/50) comptaient parmi les exemples courants de facteurs liés à l’équipe. Tous les facteurs identifiés comme étant systémiques étaient liés à des procédures administratives inadéquates.

Conclusion

Nous recommandons aux cliniciennes et cliniciens de réaliser des examens physiques appropriés, de se tenir au courant des normes cliniques et de s’assurer que leur documentation reflète leur évaluation, l’état du/de la patient·e et la justification du traitement.

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Author contributions

Emma MacLean contributed to analysis and drafting of the article. Gary Garber contributed to data acquisition and analysis, interpretation of data, and drafting the article. Kate Barbosa contributed to data acquisition and analysis, interpretation of data, and drafting the article. Richard Liu contributed to data acquisition and analysis, interpretation of data, and drafting the article. Allison Verge contributed to conception of the article and review of the manuscript. Karim Mukhida contributed to conception of the article, review of the data, and drafting the article.

Acknowledgements

Emma MacLean’s work on this project was supported by a Research in Medicine studentship provided by the Faculty of Medicine at Dalhousie University, Halifax, NS, Canada.

Disclosures

None of the authors have any conflicts of interest to declare.

Funding statement

This study was not funded.

Editorial responsibility

This submission was handled by Dr. Philippe Richebé, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

    Emma MacLean BScN & Karim Mukhida MD, PhD, MBA

  2. Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada

    Gary Garber MD, Kate Barbosa RN, BScN & Richard Liu MCS

  3. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Gary Garber MD

  4. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Gary Garber MD

  5. Department of Anesthesia, Pain Management & Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

    Allison Verge MD & Karim Mukhida MD, PhD, MBA

  6. Pain Management Unit, Queen Elizabeth II Health Sciences Centre, 4th Floor Dickson Building, Halifax, NS, B3H 1K5, Canada

    Karim Mukhida MD, PhD, MBA

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MacLean, E., Garber, G., Barbosa, K. et al. Lessons learned from examination of Canadian medico-legal cases related to interventional therapies for chronic pain management. Can J Anesth/J Can Anesth 70, 1504–1515 (2023). https://doi.org/10.1007/s12630-023-02531-1

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