Influence of claims on the management of an orthopaedic surgery and traumatology service

A Combalia; I Torà-Rocamora; A Diestre-Tomas; E Muñoz-Mahamud; J Grau- Cano; A Prat-Marín

doi:10.1016/j.recot.2022.01.004

Influence of claims on the management of an orthopaedic surgery and traumatology service

Rev Esp Cir Ortop Traumatol. 2022 Nov-Dec;66(6):469-476. doi: 10.1016/j.recot.2022.01.004. Epub 2022 Mar 7.

[Article in English, Spanish]

Authors

A Combalia¹, I Torà-Rocamora², A Diestre-Tomas², E Muñoz-Mahamud³, J Grau- Cano², A Prat-Marín²

Affiliations

¹ Servicio de Cirugía Ortopédica y Traumatología, Institut Clínic de Especialidades Mèdicas y Quirúrgicas, Departament de Cirugía, Hospital Clínic-Facultat de Medicina, Universitat de Barcelona, Barcelona, España. Electronic address: combalia@clinic.cat.
² Servicio de Medicina Preventiva i Epidemiologia, Institut Clínic de Medicina y Dermatología, Departament de Medicina, Hospital Clínic-Facultat de Medicina, Universitat de Barcelona, Barcelona, España.
³ Servicio de Cirugía Ortopédica y Traumatología, Institut Clínic de Especialidades Mèdicas y Quirúrgicas, Departament de Cirugía, Hospital Clínic-Facultat de Medicina, Universitat de Barcelona, Barcelona, España.

PMID: 35272976
DOI: 10.1016/j.recot.2022.01.004

Abstract

Introduction: Claims constitute one of the main sources of information to evaluate the perceived quality in healthcare centres, being Orthopaedic and Traumatology Surgery (OTS) one of the specialties with greater probability of receiving them due to its high surgical demand generating long waiting lists.

Objectives: To display the evolution of the filed claims addressed to the OTS department, to classify the reasons stated in the complaint, and to identify the opportunities for improvement derived from the forementioned.

Methodology: Descriptive, observational and retrospective epidemiological study. The target population has been configured by those citizens who have submitted a claim addressed to the OTS Service of a University Hospital of Barcelona from 2014 to 2018. In reference with the classification of claims, it has been used the reasons established by the public service CatSalut: assistance, treat, information, organisation, documentation and hospitality/habitability/comfort.

Results: OTS service received a total of 424 claims during the study period, showing an overall rate of 3.18 claims per 100 assistance episodes considered. The main reasons for claiming were organizational (73%) and assistance (20%). No claims regarding dissatisfaction of hospitality/habitability/comfort were registered. A noticeable decrease in the number of claims submitted is observed since 2016.

Conclusion: Actions in the management of waiting lists and standardised information procedures that improve the doctor-patient relationship have been identified as measures of improvement to reduce the claim presentation rate.

Keywords: Calidad asistencial; Clinical management; Gestión clínica; Medical claims; Quality care; Reclamaciones.