Trends in Pediatric Malpractice Claims 1987-2015: Results From the Periodic Survey of Fellows.

Background: Pediatricians are less frequently sued than other physicians. When suits are successful, however, the average payout is higher. Little is known about changes in the risk of litigation over time.

Understanding Liability Risks and Protections for Pediatric Providers During Disasters.

Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been at the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster.

Understanding Liability Risks and Protections for Pediatric Providers During Disasters.

Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been in the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster.

A Misdirected Patient Transfer Raises Emergency Medical Treatment and Labor Act Liability Issues.

Children often require transfer to pediatric hospital emergency departments (EDs) after evaluation in community hospital EDs. Such transfers are regulated by the federal Emergency Medical Treatment and Labor Act. Unusual circumstances, such as logistical errors in the physical transfer of the patient, may increase Emergency Medical Treatment and Labor Act-related liability risks for hospitals and ED physicians.

Relative productivity of nurse practitioner and resident physician care models in the pediatric emergency department.

Objectives: Duty hour restrictions limit the use of resident physicians in pediatric emergency departments (PEDs). We sought to determine the relative clinical productivity of PED attending physicians working with residents compared with PED attending physicians working with nurse practitioners (NPs).

Methods: In a tertiary care PED with multiple care models (PED attending physicians with residents and/or fellows, PED attending physicians with NPs, PED attending physicians alone), we identified periods when care was provided concurrently and exclusively by a PED attending physician with 1 to 2 residents (resident pod) and a PED attending physician with 1 NP (NP pod).

Biomarkers of Dose and Effect of Inhaled Ozone in Resting versus Exercising Human Subjects: Comparison with Resting Rats.

To determine the influence of exercise on pulmonary dose of inhaled pollutants, we compared biomarkers of inhaled ozone (O3) dose and toxic effect between exercise levels in humans, and between humans and rats. Resting human subjects were exposed to labeled O3 ((18)O3, 0.4 ppm, for 2 hours) and alveolar O3 dose measured as the concentration of excess (18)O in cells and extracellular material of nasal, bronchial, and bronchoalveolar lavage fluid (BALF).

Ozone exposure-response model for lung function changes: an alternate variability structure.

Context: A statistical model that accurately predicts human forced expiratory volume in one second (FEV1) response to ozone exposure has been identified and proposed as the foundation for future risk assessments for ambient ozone. We believe that the assumptions about intra-subject variability in the published model can be improved and hypothesize that more realistic assumptions will improve the fit of the model and the accuracy of risk assessments based on the model.

Objective: Identify alternate assumptions about intra-subject variability and compare goodness-of-fit for models with various variability structures.

Prediction of lung function response for populations exposed to a wide range of ozone conditions.

Context: A human exposure-response (E-R) model previously demonstrated to accurately predict population mean FEV₁ response to ozone exposure has been proposed as the foundation for future risk assessments for ambient ozone.

Objective: Fit the original and related models to a larger data set with a wider range of exposure conditions and assess agreement between observed and population mean predicted values.

Materials And Methods: Existing individual E-R data for 23 human controlled ozone exposure studies with a wide range of concentrations, activity levels, and exposure patterns have been obtained.

Moving on up: is it safe for patients to relocate to higher altitude following the fontan procedure?

The change in clinical status of patients status post-Fontan surgery who relocated from low (<1,500 feet) to moderate (>4,000 feet) altitude was assessed. Cardiology databases were queried for patients meeting inclusion criteria. The clinical records of these patients for the 6 months before and 6 months after relocation were then reviewed.

Challenging assumptions about uninsured children in the pediatric emergency department.

Objective: Emergency departments (EDs) are experiencing increased volumes and crowding problems. Although crowding is often blamed on uninsured patients, the role of uninsured children is unclear. We compared ED use by insured and uninsured children.

Does the emergency medical treatment and labor act affect emergency department use?

Background: Emergency departments (EDs) face increasing patient volumes and economic pressures. These problems have been attributed to the Emergency Medical Treatment and Labor Act (EMTALA).

Study Objective: To determine whether modifying EMTALA might reduce ED use.

When bad things happen: adverse event reporting and disclosure as patient safety and risk management tools in the neonatal intensive care unit.

The Institute of Medicine has recommended a change in culture from "name and blame" to patient safety. This will require system redesign to identify and address errors, establish performance standards, and set safety expectations. This approach, however, is at odds with the present medical malpractice (tort) system.

Should we fear "flu fear" itself? Effects of H1N1 influenza fear on ED use.

Background: Surges in patient volumes compromise emergency departments' (EDs') ability to deliver care, as shown by the recent H1N1 influenza (flu) epidemic. Media reports are important in informing the public about health threats, but the effects of media-induced anxiety on ED volumes are unclear.

Objective: The aim of this study is to examine the effect of widespread public concern about flu on ED use.

Lights, camera, action… spotlight on trauma video review: an underutilized means of quality improvement and education.

Background: Trauma video review (TVR) is an effective method of quality improvement and education. The objective of this study was to determine TVR practices in the United States and use of TVR for quality improvement and education.

Methods: Adult and pediatric trauma centers identified by the American College of Surgeons (n = 102) and the National Association of Children's Hospitals and Related Institutions (n = 24) were surveyed by telephone.

Pediatric emergency department use by adults with chronic pediatric disorders.

Objective: To describe pediatric emergency department use by adults with chronic pediatric disorders, known as transition patients.

Design: Retrospective descriptive study.

Setting: The pediatric emergency department of a tertiary care pediatric hospital during calendar year 2005.

The reimbursement gap: providing and paying for pediatric procedural sedation in the emergency department.

A number of medical, ethical, and legal obligations compel physicians to provide procedural sedation and analgesia (PSA) to pediatric patients requiring painful procedures in the emergency department (ED). Recognizing the additional demands that PSA places on ED physicians, the American Medical Association has approved Current Procedural Terminology codes for PSA in conjunction with ED procedures. However, some insurers have indicated reluctance or refusal to pay for PSA in the ED, despite these Current Procedural Terminology codes and the legal and ethical imperatives.

Prediction of ozone-induced lung function responses in humans.

The main purpose of this study was to evaluate the ability of a human exposure-response model, which describes ozone-induced changes in forced expiratory volume in 1 second (FEV1) across a wide range of dynamic exposure conditions, to predict responses in independent data. We first conducted an n-fold cross-validation of the model using samples of the original EPA data from which the model was developed. We then identified seven more recently published studies with controlled exposures to a wide range of ozone exposure patterns relevant to the current ambient ozone health standard and used the model to calculate the mean predicted responses for the exposure conditions of the individual studies that we compared to the mean observed responses reported in these studies.

Critical considerations in evaluating scientific evidence of health effects of ambient ozone: a conference report.

The U.S. Environmental Protection Agency (EPA), under the authority of the Clean Air Act (CAA), is required to promulgate National Ambient Air Quality Standards (NAAQSs) for criteria air pollutants, including ozone.

Medical diagnoses commonly associated with pediatric malpractice lawsuits in the United States.

In this article we discuss the medical diagnoses underlying the most common lawsuits involving pediatricians in the United States. Where applicable, specific and general risk-management techniques are noted as a means of increasing patient safety and reducing the risk of medical malpractice exposure.

Narrative review: do state laws make it easier to say "I'm sorry?".

Initiatives intended to reduce the frequency and impact of medical errors generally rely on recognition and disclosure of medical errors. However, fear of malpractice liability is a barrier to physician disclosure. Some U.

Effects of exposure to 0.06 ppm ozone on FEV1 in humans: a secondary analysis of existing data.

Background: Ozone is a potent photochemical oxidant that produces transient, reversible decrements in the lung function of acutely exposed individuals. A recent study provided previously unavailable clinical data for 30 healthy young adults exposed to O(3) at 0.06 ppm.

The temporal dynamics of ozone-induced FEV1 changes in humans: an exposure-response model.

Although ozone is known to induce reversible decrements in forced expiratory volume in 1 s (FEV1), no exposure-response model has been identified that accurately describes the dynamics of response to the changing concentrations and activity patterns of normal ambient human exposure. The purpose of the current analysis was to identify and evaluate a dynamic model of FEV1 response using a large existing data set (541 volunteers, 864 exposures, 3485 FEV1 measures) with a wide range of exposure conditions (ozone = 0.0 to 0.