[Institutional investigations on clinical adverse events]

It is hard to narrowly define institutional investigations on clinical adverse events because of their variety: including which kinds of professional participate in drafting a report, whether a report focuses on measures to improve quality and safety in healthcare, the manner in which a committee communicates with patients and their families, whether there is licensing, civil or criminal procedures involved, and the manner in which a committee discloses its report and related facts to the media Institutional investigations and reports have several headwaters to overcome. Clinicopathological conferences provide useful methods to investigate adverse events, although they are not well structured to communicate with patients and families. Medical malpractice lawsuits also have given medical professionals a certain distorted style in their ability to openly discuss adverse events. The Japanese Society of Internal Medicine, cooperating with other medical societies, has managed for 4 years a project for the investigation of deaths associated with medical practice. That project has been providing both better methods of investigation and of communication with patients.