QRB. Quality review bulletin
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The development of clinically based written standards to reduce the frequency and severity of medical malpractice loss appears to be gaining in popularity among provider specialty groups and professional liability underwriters. To date, such standards have addressed problems in specialties such as obstetrics and anesthesia where dollar losses associated with malpractice claims have been high. Guidelines can be developed and used by providers on a purely voluntary basis or mandated on an involuntary basis by third parties such as malpractice insurance companies or legislators. ⋯ Many providers are understandably concerned about the potential use of written standards by plaintiff attorneys in medical malpractice suits. Although it is possible that such policies and guidelines could be admitted into evidence to show that a provider breached the legal duty or standard of care owed to a patient, it is uncertain whether these risk-control standards could ultimately pass the evidentiary rules of relevancy or materiality in a given lawsuit. It is clear, however, that the consensus-based process of creating clinical standards and guidelines specifically for controlling professional liability losses is itself a powerful and emerging standard for health care risk management programs.
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Anesthesiology is considered a leading specialty with respect to medical risk management and patient safety. The American Society of Anesthesiologists (ASA) developed its first practice guidelines in 1968 and published its first set of stricter practice standards in 1986. The standards are detailed specifications for the minute-to-minute conduct of anesthesia practice. An impetus for ASA standards development has been the belief that physicians should develop their own standards rather than have them imposed by nonphysician third parties.