Adverse event, negligence or malpractice: The debate revisited

Determining whether an incident in healthcare is an adverse event, negligence or malpractice can be challenging. The authors previously proposed a three-pronged model considering the magnitude of harm, the frequency of similar incidents and the intention behind the actions. However, on reflection and testing, they have identified limitations in the model. Magnitude is subjective, frequency is difficult to gauge and intention is impossible to assess. The authors now propose a refined template that replaces Frequency with Perceived Harm, better defines how Magnitude can be gauged and replaces Intention with a more objective measure of Fitness for Purpose. It also introduces a fourth category of Accountability (a measure of professionalism). The updated model includes a graphical representation using Visual Analogue Scales, with the aim to aid in determining whether an incident is an adverse event, negligence or malpractice. The respondents/assessors will mark a point on each of the four scales that best indicates their assessment of that category. These points can then be measured and the totals used to rank the severity of the incident. This paper once again emphasises how important it is for clinicians to maintain accurate and detailed records, the need for teaching and practicing evidence-based medicine, of prioritising the patient’s best interests, and of timely reporting of suspected misconduct to the HPCSA in order to protect patients.