Anesthesiology 2007; 106:675– 80 Copyright © 2007, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Analysis of Deaths Related to Anesthesia in the Period 1996 –2004 from Closed Claims Registered by the Danish Patient Insurance Association Lars Dahlgaard Hove, M.D.,* Jacob Steinmetz, M.D.,† Jens Krogh Christoffersen, M.D.,‡ Ann Møller, M.D.,§ Jacob Nielsen, M.D.,§ Henrik Schmidt, M.D. Background: Anesthesia is associated with complications, and some of them may be fatal. The authors investigated the circumstances under which deaths were associated with anes- thesia. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anes- thetic procedures, perioperative care medicine, and intensive care medicine. Methods: The authors retrospectively investigated anesthesia related deaths registered by the Danish Patient Insurance Asso- ciation. Results: From 1996 to 2004, 27,971 claims were made by the Danish Patient Insurance Association covering all medical spe- cialties, of which 1,256 files (4.5%) were related to anesthesia. In 24 cases, the patient’s death was considered to result from the anesthetic procedure: 4 deaths were related to airway man- agement, 2 to ventilation management, 4 to central venous catheter placement, 4 as a result of medication errors, 4 from infusion pump problems, and 4 after complications from re- gional blockades. Severe hemorrhage caused 1 death, and in 1 case the cause was uncertain. Conclusions: Several of the 24 deaths could potentially have been avoided by more extended use of airway algorithm, thor- ough preoperative evaluation, training, education, and use of protocols for diagnosis and treatment. IT has become accepted that patients can file a claim if their medical treatment results in an injury or an unex- pected side effect. In Denmark, claims from patients regarding medical treatment are considered by the inde- pendent Danish Patient Insurance Association (DPIA) introduced in 1992 by the Danish government. The DPIA acts as an impartial agency, with the power to provide financial compensation to patients for injuries sustained during examination or treatment in the healthcare ser- vice. 1 As a result, patients can file a claim with the DPIA with the sole purpose of seeking financial compensa- tion. Based on the DPIA files covering claims from 1996 to 2004, we evaluated the fatal cases related to the fields of anesthesia in Denmark. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anesthetic procedures, perioperative care medicine, and intensive care medicine. The number of anesthesias per- formed in Denmark per year is estimated to be 400,000. The aim of this study was to describe the set of claims that resulted from death associated with anesthesia and to identify potential opportunities to improve patient safety. Materials and Methods The study used a retrospective design that followed claims for financial compensation as listed in the DPIA database launched in 1996. The claim from a patient comprises a description of the injury (injuries) in addi- tion to the medical record. Each case is registered in the database under a code that identifies the patient and the medical specialty involved. A claim for financial compensation can be made by the injured patient, the relatives, or the hospital. When a patient files a claim, the hospital is obliged to submit all medical records regarding the case to the DPIA. A lawyer evaluates the claim and may seek advice from medical specialists. Since 2002, cases regarding anesthesia have been handled by a permanently employed anesthesiolo- gist, who provides an evaluation as to whether “best practice” has been followed. Before 2002, a medical specialist without anesthesiology training provided ad- vice for simple claims, and an external consulting anes- thesiologist (usually a professor) provided advice for more complex claims. In general, financial compensation is granted if (1) an experienced specialist would have acted differently; (2) defects in, or failure of the technical equipment were of major concern with respect to the incident; or (3) alter- native treatments, techniques, or methods were consid- ered to be more safe and potentially offer the same benefits. At least one of the three conditions must be fulfilled before compensation is granted. In addition, an injury may lead to financial compensation if the injury is rare and more extensive than the patient would be expected to endure. It is important to note that financial compensation can be granted even in claims where no medical errors were made. The lawyer determines, in This article is accompanied by an Editorial View. Please see: Heitmiller E, Martinez E, Pronovost PJ: Identifying and hope- fully learning from mistakes. ANESTHESIOLOGY 2007; 106:654 – 6.  * Staff Doctor, § Consultant, Department of Anesthesia, University Hospital of Herlev, Denmark. † Staff Doctor, University Hospital of Copenhagen (Rigshos- pitalet), Denmark. ‡ Consultant, Danish Patient Insurance Association, Den- mark.  Consultant, University Hospital of Odense, Denmark. Received from the Department of Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Submitted for publication May 12, 2006. Accepted for publication December 8, 2006. Support was provided solely from institutional and/or departmental sources. Address correspondence to Dr. Hove: Department of Anesthesiology, Rigshos- pitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. larshove@dadlnet.dk. Individual article reprints may be purchased through the Journal Web site, www.anesthesiology.org. Anesthesiology, V 106, No 4, Apr 2007 675 Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/106/4/675/364194/0000542-200704000-00008.pdf by guest on 13 June 2022