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Published 31 March 2022
NHS Resolution has published three important reports on claims arising out of care provided in Emergency Departments in England, with the aim of preventing incidents leading to claims. As Helen Vernon, the Chief Executive at NHS Resolution, notes in her foreword to the reports, emergency medicine has been either first or second in terms of new claim notifications every year for the past decade. These claims have “an immeasurable impact on patients, their families and the healthcare staff involved”, and they can be used as “a resource for improvement”, which is the objective of these three reports.
The reports focus on three key areas: (i) high-value and fatality-related claims, (ii) missed fractures, and (iii) hospital-acquired pressure ulcers and falls. In this article we look at some of the key points arising out of each of the reports.
For this report NHS Resolution conducted a thematic review of 16 claims that were valued at more than £1 million and also 86 claims involving patient deaths. The review identified five common and emergent themes:
The report makes a range of recommendations to seek to address these themes, for example:
According to this report, 5.1% of all ED attendances in 2018/19 were because of a dislocation, fracture, joint injury or amputation. In a very small proportion of these attendances a fracture that could have been identified and treated was missed, with consequent harm to the patient. For this report NHS Resolution reviewed 78 cases of this nature that arose in previous years (2015/15 and 2017/18) and some of its key findings can be summarised as follows:
In terms of recommendations, the report notes that there are already existing standards and guidelines which, if they had been fully implemented and followed, would have prevented fractures from being missed in most cases. However, it acknowledges that there were wider factors that influence what happens in EDs, including “demand, capacity and outflow”. Nonetheless, the report makes several important recommendations, which are separated into five themes, i.e. (i) workforce, (ii) models of care, (iii) ED multidisciplinary meetings, (iv) training and competence, (v) hip fractures. The recommendations include the following:
NHS Resolution reviewed 15 patients who had more than one pressure ulcer site. It is recognised this is only a small number of claims, however, the findings can be summarised as follows:
NHS Resolution analysed a total of 220 ED claims, of which 35 involved patients falling. The review found:
The report identifies four themes and provides the following recommendations:
Reporting and investigating incidents:
By analysing clinical negligence claims NHS Resolution has been able to draw on an important source of knowledge in order to prepare these reports, which contain valuable insights and recommendations that should, when implemented, make a significant contribution to improving patient safety in Emergency Departments. Claims involving care provided in Emergency Departments cost the NHS more than £300 million in damages and legal costs in 2020/21, with significant impacts on patients, their families, and medical professionals involved in their care. These reports highlight that, although Emergency Departments are currently operating under a great deal of pressure, there are certain practical steps that Trusts can take to avoid incidents such as missed fractures, pressure ulcers and falls in particular. These should help to drive down the NHS’s expenditure on claims, and will no doubt lead to better experiences for patients and staff alike.
A link to the reports can be found here.
Please contact Sean Doherty, Heather Durston-Hillyer, Ciaran Claffey or Charlotte Kistell-Gough if you wish to discuss these reports further.
+44 (0)113 251 4807
+44 (0) 1962 705502
+44 (0)1962 705513
+44(0)113 251 4713
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