Integrating rain classroom with case-based learning in teaching dental hard tissue non-carious diseases: a comparative study.

As populations rapidly age, patient safety in geriatric care has become a crucial challenge for healthcare systems worldwide [, ]. Delirium affects 10%–30% of older hospitalized adults and poses a significant safety concern [, , ]. Delirium-related adverse events include falls, self-removal of medical devices, patient elopement, and physical restraint injuries. These adverse events not only worsen clinical outcomes and increase healthcare costs [–] but also reflect system-level vulnerabilities in patient safety [, ] and elevate the risk of medical disputes [–]. Although these phenomena have been reported internationally, the relationship between adverse events and medical disputes remains understudied. Previous studies on medical disputes have mainly assessed closed claims or litigation data alone, which may not fully capture the true impact of adverse events []. Litigation data is particularly constrained by small sample sizes and is susceptible to selection bias. Medical disputes impose severe psychological and social burdens on patients, families, and healthcare providers, while also incurring substantial costs for healthcare systems [, ]. Therefore, identifying patterns of adverse events that escalate into malpractice claims is essential for prevention. Comparing closed claims with adverse events from a national database could help identify which types of adverse events are more likely to escalate into disputes. However, systematic investigation of this topic remains lacking both domestically and internationally. Given the limited number of closed claim cases, this study is exploratory and primarily aimed at hypothesis generation. Specifically, we aim to: (1) compare failure modes between delirium-related adverse events reported to a national incident database and those documented in closed malpractice claims, and (2) investigate associations between failure modes and dispute outcomes, laying the groundwork for future prospective, international comparative studies.