Review of Malpractice Claims in Infants with Retinopathy of Prematurity

July 19, 2009

In a study published in the July issue of the Archives of Ophthalmology, researchers reviewed the closed retinopathy of prematurity (ROP) malpractice claims filed with the Ophthalmic Mutual Insurance Company (OMIC) to classify the reasons for the claims. Eight cases involved a failure of transfer of care after discharge of the patient from the hospital, 3 cases demonstrated long periods between follow-up exams, 1 case was due to a failure of outpatient referral to the treating ophthalmologist, and 1 case involved unsupervised ROP care by a resident.

The authors note that the management of ROP is very complex and that there needs to be a systematic process or checklist that is activated when the screening for ROP begins. The following is a summary of  the recommendations from OMIC reviewed in the article and designed to ensure appropriate ROP screening practices and treatment for both inpatients and outpatients:

  1. Update and review current ROP screening and treatment guidelines with all parties involved in the care of premature infants including neonatologists, ophthalmologists, pediatricians and parents.
  2. Activate a hospital ROP tracking system on the birth of infants who meet the age and weight requirements for ROP screening.
  3. Designate an ROP coordinator to follow up with patients identified by the tracking system, ensure appropriate timing of screening examinations while patients are in the hospital, and coordinate the initial follow-up appointments once patients leave the hospital.
  4. Make written follow-up appointments before discharge for any patient who has not met the criteria for the conclusion of ROP screening.
  5. Attending physicians must supervise residents who participate in any ROP examinations.
  6. Assume primary responsibility for ensuring further follow-up and managing the transfer of care between different ophthalmic specialists after the patient is discharged from the hospital.
  7. Create and implement an office-based ROP tracking system for outpatients. Institute a follow-up protocol for all changed or missed appointments.

For more detailed guidelines and forms about ROP screening and management, please refer to “ROP: Creating a Safety Net” by Menke AM, available on the OMIC Web site.

Read the abstract or article here (log in required).




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