Risk management in Primary Care: paediatric cases

Objective: To assess the safety of health care to patients in paediatric age, analysing the patrimonial responsibility dossiers against the extinguished Insalud. Material and methods: An observational, descriptive, transversal study; it were analysed all 56 dossiers in paediatric age by a work team with a large professional experience in Primary settings was conformed. A technical document with proceedings and clinical specific judgement was accorded. The statistic analysis was made with the SPSS version 11 and S-Plus version 6.0 programs. Results: The paediatric cases accounted for 12.64% of total (443) of claims in primary care in the analysed period (1995-2001); the average age of 4.81 years, being the males 57.15%. In 53.57% of administrative dossiers there had not clinical records or its quality was not acceptable. Physical or organic sequelae were present in 53.75%; and death in 23.21%. Diagnostic error was identified in 64.30% of claims, and probable medical malpractice in 35.71% of cases (37% in global study). According with CIE-9, groups XVII (28, 57%), VI (10.71%), VIII (8.92%),X (8.92%) and XVI (8.92%) were prevalent. Conclusions: The pediatric cases analysis give better results than that we found in the overall number in primary care. The majority of claims are based on alleged medical errors. The rural areas deserved by general practitioners, present an increased risk of medical malpractice. When the attendant physician was paediatrician the minor percentage of malapraxis was found. To implement specific programmes of risk healthcare management will help to increase the quality and safety of patients.