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1. LOSA: The provider does not seem to be aware of data/evidence or ignores data/evidence in the course of diagnosis or treatment. a. Diagnostic: Wrong diagnosis in face of symptoms, signs, radiological, and laboratory evidence b. Therapeutic/Surgical: Wrong operation (wrong site, wrong organ, wrong procedure), Medical: Wrong medication or treatment for the diagnosis c. Chronologic: Does not act to treat or diagnosis in the face of progressive changes in the patient (e.g., does not act to transfuse a patient in the face of progressive development of hypotension postoperatively) 2. IMSAFE a. Illness. b. Medications. Particularly antihistamines, narcotics, sedatives, minor and major tranquilizers c. Stress. d. Alcohol or other substances legal or not that affect cognition e. Physiologic. Fatigue, hunger, or need to use the restroom f. Emotion. Anger, depression. May be indicated by provider refusing to treat or see patient. 3. Hazardous attitudes a. Antiauthority. Performs a treatment or procedure outside accepted norms, or uses standard treatments or procedures in nonstandard ways (e.g., some alternative treatments). b. Macho. Takes a chance. Treats patient when other safer alternatives are available (e.g., does a medical or surgical treatment that could have waited and been done at another facility better able to handle a specific problem). This does not include doing a diagnostic or therapeutic measure emergently, usually. c. Impulsivity. Transfers patient without first stabilizing, performs treatment without first gathering all necessary information. d. Invulnerability. Refuses to treat, ignores concerns from medical team or patient, treats family or employees, or provides treatment or advice to someone outside the standard medical environment casually (can be signs of this attitude if done where someone else could have done it, or takes chances on family or employees that would have not normally been done), doing a procedure without informed consent (if not an emergency procedure). e. Resignation (e.g., ignoring a patient with terminal illness, not trying to diagnose or treat a patient). 4. Medical team resource management/leadership a. Poor communication among members of the team. i. Not informing members of the situation ii. Failing to ensure that information was received iii. Ignoring or dismissing information offered by team members b. Stating derogatory comments about other members of the team c. Dressing down a team member in public. 5. External pressure a. Are demands, requests, highly encouraged desires, etc., placed on a provider by the patient, patient’s family, provider’s family, institutions, or the provider him/herself? Court Cases† LOSA IMSAFE Attitude Team Pressure Total Number. of Criteria* Class HvP, NIM 1 1 1 3 A LvWU 2 3 5 A LvGS 2 2 B FvK 0 C BvW 1 1 C CvN 1 1 C MvD 1 1 C BvB 0 C KvK 1 1 C BuvBe 2 2 4 A VvO 1 1 C HvB 1 1 C FvM 1 1 C KvG 1 1 C MvP 1 1 2 B EvR 1 1 C SvD 1 1 1 3 A NvA 2 2 B MvMBG 2 3 5 A LvJM 1 1 2 B SvPP 1 4 5 A FvCHW 2 2 4 8 A AvCL 3 1 4 A PvG 4 4 A MvSBR 2 2 4 A DvUISL 4 1 3 8 A OvO 2 2 B SvH 2 4 6 A SvM 3 3 A SvD 4 3 7 A * The number of times a reviewer thought that the criteria applied to the case.
† AvB, Initial of plaintiff versus initial of defendant.
Reviewers LOSA IMSAFE Attitudes Team Pressures Overall Kappa Value S&W 0.310 0.460 0.300 0.330 0 0.333* F&W −0.015 0.600 0.460 0.800 0 0.463* B&W 0.150 0.600 0.270 0.800 0 0.615* B&F 0.090 1.000 0.520 0.870 0 0.408* S&F 0.110 0.600 0.370 0.460 0 0.290* S&B 0.430 1.000 0.370 0.540 0 0.495* Average 0.179 0.710 0.381 0.633 0 SD 0.162 0.231 0.094 0.220 0 * Statistically significant overall Kappa values (P < .001).
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