Simone Grassi ¹ Maddalena Grazzini ² Marta Guerini ¹ Giorgio Bertana ¹ Linda Pompeo ¹ Diana Paolini ² Fabrizio Niccolini ² Martina Focardi ^1* Vilma Pinchi ¹

• ¹ University of Florence, Florence, Italy
• ² Careggi University Hospital, Florence, Tuscany, Italy

Introduction: Healthcare-associated infections are the main reported adverse event in healthcare, with significant economic costs, that include those caused by medical malpractice claims. In Italy, there is a fault-based compensation system but in this specific field the burden of proof on the hospitals is particularly heavy. Hence, we aimed to verify the economic impact of the inclusion of experts in hospital infections surveillance into internal committees for claims assessment and to evaluate what would have been the economic impact of a mandatory no-fault system rather than the current system.Materials and methods: we compared two four-year periods (T1: 2015-2018 and T2: 2019-2022), investigating the medical malpractice claims related to healthcare-associated infections in a large tertiary public hospital in Florence, Italy. Decisions of internal committee, evolutions of the claims after decision, and conclusions of the claims were registered. No-fault system simulations were used to evaluate the cost-effectiveness of the model.: we observed a decrease in the number of claims after the implementation of infection prevention and control (IPC) experts into the committee (24% decrease in rejections, 19% increase in admissions). We found a 6.806,98 euros difference (not statistically significant) in compensations in T1 and T2. Moreover, our simulations found that a no-fault compensation systemif alternative to the traditional fault-based approachcould lead to gains or losses for the plaintiffs depending on the approach chosen (we observed a 52% mean decrease in compensations with a 150.000 euros maximal indemnity and a 134% mean increase with an indemnity tailored considering also life expectancy).Discussion: introducing experts in IPC into hospital committees for the medico-legal claims management proved to be cost-effective, as a no-fault compensation system alternative to the traditional fault-based approach with a properly evaluated maximal indemnity. Since the limitations of our models, multicentric studies to verify our results are recommended.