Closed Claims Project

Karinne M. Jervis

Richard D. Urman

Fred E. Shapiro

The Closed Claims Project, established in 1984 by the American Society of Anesthesiologists (ASA), was formed to recognize and formulate procedures to prevent anesthesia-related complications. The driving force behind this study was the dichotomy between the number of anesthesiologists and the amount of malpractice claims. At that time anesthesiologists comprised only 3% of the population of physicians; however they accounted for 11% of the total malpractice claims—an inordinate amount compared with the number of physicians. The ASA Closed Claims Project is conducted by the ASA Committee on Profession Liability. This committee comprised 35 insurance companies and anesthesiology reviewers that review closed claims that were anesthesiology-related. The information and statistics provided by the Closed Claims Project has influenced the practice of anesthesia and stimulated research in multiple areas—especially in the burgeoning areas of office-based anesthesia. Owing to the identification of adverse effects complied with in the 30-year review, the practice of anesthesia has become safer since the inception of the Closed Claims Project, and further extrapolation of data from 3 decades of research to the new area of office-based anesthesia will make this uncharted and under-investigated area of anesthesia safer as well.

LESSONS LEARNED FROM THE STUDY

The compilation of data has demonstrated that most of the claims have occurred with the following:

Healthy adults undergoing elective procedures
Women (59% of claims)
Adults (91% of claims)
ASA 1 or 2 (69% of claims)

Lessons learned from the study demonstrated the need for further monitoring of patients under anesthesia. After the implementation of further monitoring, pulse oximetry, and end-tidal capnography, the rate of preventable anesthetic complications, if further monitoring had been employed, decreased from 39% of claims in the 1970s to 9% in the 1990s (1,2).

HOW DOES THIS INFORMATION PERTAIN TO OFFICE-BASED ANESTHESIA?

To date, there have only been a few claims from the office-based anesthesia setting, but there are some startling and interesting comparisons between the Closed Claims Project data of the 1980s and the early 2000s (see Table 8.1 and Figure 8.1). If you believe in the philosophy that “history repeats itself,” this is an excellent example (3). Interestingly, the demographics of the following claims are similar:

Middle-aged women
ASA 1 or 2
Elective surgery
General anesthesia

Adverse events included the following:

Airway obstruction (bronchospasm/laryngospasm)
Inadequate ventilatory support
Drug errors

Table 8.1. Comparisons between the Closed Claims Project data of the 1980s and the early 2000s

		Ambulatory Anesthesia (n = 753)	Office-Based Anesthesia (n = 14)
Age (mean in years)		41	45
Female (%)		58	64
ASA 1-2 (%)		82	89
Elective surgery (%)		97	100
Anesthesia type
	General (%)	66	71
	MAC (%)	10	14
Surgical procedure
	Dental (%)	3	21
	Plastic surgery (%)	32^a	21^a
	Other (%)	64^b	14^b
^ap < 0.05 Ambulatory vs. Office-Based Anesthesia ^bp < 0.01 Ambulatory vs. Office-Based Anesthesia
Percentages do not equal 100% due to rounding MAC, monitored anesthesia care.