Report on legal claims in emergency medicine

GOOD record-keeping and communication to support handover and ‘safety netting’ for patients whose condition may deteriorate are among key lessons highlighted in three new reports on compensation claims in emergency medicine.

The reports published by NHS Resolution cover high-value and fatality-related claims over £1m, missed fractures and hospital-acquired pressure ulcers and falls in emergency departments. Each contains recommendations to help prevent further incidents.

A total of 220 cases were examined with incidents occurring between 2014 and 2018 and in which a legal liability had been established.

Among the main findings the authors conclude that ED clinical services should provide timely identification of diagnoses and treatment plans for patients, including what to look out for and actions that should be taken if the patient deteriorates. This requires good record-keeping and communication to support handover and ‘safety netting’ for patients, with follow-up in a timely and appropriate manner.

Other key clinical issues highlighted in the reports are:

  • access to senior staff review, with appropriate use of multidisciplinary teams working between specialties
  • systems in place for prompt clinical imaging
  • infrastructure for appropriate escalation and handover of clinical details to senior clinical staff and specialist clinicians respectively
  • identification and proportionate clinical strategy regarding patients who regularly attend ED
  • the benefits of digital solutions to support timely and appropriate clinical decisions for patients.

Emergency medicine (EM) had among the highest number of new claim notifications to NHS Resolution over the study period but the rate was low in relation to overall activity in the ED, with a claim occurring for only one in every 17,000 episodes of ED care.

Helen Vernon, Chief Executive, NHS Resolution, said: "The number of claims is relatively small compared to how many people attend emergency medicine, although attendances are increasing year-on-year, and patients have more complex needs."

Dr Katherine Henderson, Royal College of Emergency Medicine President welcomed the reports as "learning opportunities to reduce the tragedy of preventable harm to individuals and their families as well as the staff involved".

"As specialty leaders and standard setters, we must use the stories and themes identified in these reports to focus our guidance and teaching and sharpen our advocacy for a better system of care modelled to deliver patient needs."

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