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Oglesby FC, Ray AG, Shurlock T, Mitra T, Cook TM. Litigation related to anaesthesia: analysis of claims against the NHS in England 2008-2018 and comparison against previous claim patterns. Anaesthesia 2022; 77:527-537. [PMID: 35247933 DOI: 10.1111/anae.15685] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 12/14/2022]
Abstract
We reviewed all 1230 claims against anaesthesia notified to NHS Resolution (formerly the NHS Litigation Authority, 1995-2017) in England between 2008 and 2018. Claims were categorised by incident type, severity (whether physical or psychological), and cost, and comparisons were made against a similar published analysis of data from 1995 to 2007. While the annual number of claims against anaesthesia increased by 62% from the earlier period, anaesthesia now accounts for smaller proportions of all claims submitted to NHS Resolution (1.5% vs. 2.5%) and of the total cost of all claims (0.7% vs. 2.4%). The absolute costs related to anaesthesia claims rose over 300%, totalling £145 million between 2008 and 2018, but the mean cost per closed claim (retail price index adjusted) fell by 6% to £74,883. The most common clinical categories were regional anaesthesia (24%), inadequate anaesthesia (20%) and drug administration (20%). Claims related to airway management, central venous catheterisation and cardiac arrest remained infrequent but severe and costly. The proportion of claims relating to regional anaesthesia and obstetric anaesthesia fell significantly, but claims relating to peripheral nerve blockade doubled. Our analysis includes categories relating to organisational and human factors which are present in a substantial proportion of claims; categories with the highest mean cost per claim included delayed care, planning, monitoring and consent. Overall, the specialty of anaesthesia is at low risk of litigation. Our analysis provides important insights into current and changing patterns in claim distributions that may help improve the quality of patient care and reduce future litigation. We recommend the establishment of a structure for national review and learning from all cases of litigation.
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Affiliation(s)
- F C Oglesby
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals, Bath
| | - A G Ray
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol
| | | | | | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,University of Bristol, Bristol, UK
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2
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Sivia DS, Pandit JJ. Mathematical model of the risk of drug error during anaesthesia: the influence of drug choices, injection routes, operation duration and fatigue. Anaesthesia 2019; 74:992-1000. [DOI: 10.1111/anae.14629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2019] [Indexed: 12/16/2022]
Affiliation(s)
| | - J. J. Pandit
- Nuffield Department of Anaesthesia Oxford University Hospitals NHS Trust Oxford UK
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3
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Nimmo AF, Absalom AR, Bagshaw O, Biswas A, Cook TM, Costello A, Grimes S, Mulvey D, Shinde S, Whitehouse T, Wiles MD. Guidelines for the safe practice of total intravenous anaesthesia (TIVA). Anaesthesia 2018; 74:211-224. [DOI: 10.1111/anae.14428] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 12/16/2022]
Affiliation(s)
- A. F. Nimmo
- Department of Anaesthesia; Royal Infirmary of Edinburgh; Edinburgh UK; Society for Intravenous Anaesthesia (Co-Chair of the Working party)
| | - A. R. Absalom
- Department of Anesthesiology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands: Society for Intravenous Anaesthesia
| | - O. Bagshaw
- Department of Anaesthesia; Birmingham Women's and Children's NHS Foundation Trust; Birmingham UK; Association of Paediatric Anaesthetists of Great Britain and Ireland
| | - A. Biswas
- Adult/Obstetric Anesthesiology; Sidra Medicine; Qatar Foundation; Doha Qatar; Society for Intravenous Anaesthesia
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care Medicine; Royal United Hospital NHS Foundation Trust; Bath UK; Royal College of Anaesthetists
| | - A. Costello
- Department of Anaesthesia; Milton Keynes University Hospital NHS Foundation Trust; UK; Association of
Anaesthetists Trainee Committee
| | - S. Grimes
- Department of Anaesthesia; Mid Western Regional Hospital; Limerick Ireland; College of
Anaesthesiologists of Ireland
| | - D. Mulvey
- Department of Anaesthesia; Derby Teaching Hospitals NHS Foundation Trust; Derby UK; Society for Intravenous Anaesthesia
| | - S. Shinde
- Department of Anaesthesia; North Bristol NHS Trust; Bristol UK; Association of Anaesthetists (Co-Chair of the Working Party)
| | - T. Whitehouse
- Department of Anaesthesia and Critical Care; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK; Intensive Care Society
| | - M. D. Wiles
- Department of Anaesthesia; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK; Editor, Anaesthesia
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4
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Wahr J, Abernathy J, Lazarra E, Keebler J, Wall M, Lynch I, Wolfe R, Cooper R. Medication safety in the operating room: literature and expert-based recommendations. Br J Anaesth 2017; 118:32-43. [DOI: 10.1093/bja/aew379] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 01/19/2023] Open
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5
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Baruah U, Karthiga R, Subramaniam R. Intravenous mishap following residual anesthetic drug in intravenous extension line. Saudi J Anaesth 2017; 11:375-376. [PMID: 28757857 PMCID: PMC5516519 DOI: 10.4103/sja.sja_80_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Udismita Baruah
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi, India
| | - R Karthiga
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi, India
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6
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Bodenham Chair A, Babu S, Bennett J, Binks R, Fee P, Fox B, Johnston AJ, Klein AA, Langton JA, Mclure H, Tighe SQM. Association of Anaesthetists of Great Britain and Ireland: Safe vascular access 2016. Anaesthesia 2016; 71:573-85. [PMID: 26888253 PMCID: PMC5067617 DOI: 10.1111/anae.13360] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 12/13/2022]
Abstract
Safe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices.
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Affiliation(s)
- A Bodenham Chair
- Anaesthesia and Intensive Care, Leeds Teaching Hospitals, Leeds, UK
| | - S Babu
- Anaesthesia, North Manchester General Hospital, Manchester, UK
| | - J Bennett
- Anaesthesia, Birmingham Children's Hospital, Birminham, UK
| | - R Binks
- Airedale Hospital and Faculty of Intensive Care Medicine, West Yorkshire, UK
| | - P Fee
- Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - B Fox
- Anaesthesia, East Anglia, and Group of Anaesthetists in Training, AAGBI, London, UK
| | - A J Johnston
- Anaesthesia and Intensive Care, Addenbrooke's Hospital, Cambridge, UK
| | - A A Klein
- Anaesthesia, Papworth Hospital, Cambridge, UK
| | - J A Langton
- Anaesthesia, Plymouth Hospitals, Plymouth, and Royal College of Anaesthetists, UK
| | - H Mclure
- Anaesthesia, Leeds Teaching Hospitals, Leeds, UK
| | - S Q M Tighe
- Anaesthesia and Intensive Care, Countess of Chester Hospital and AAGBI Council, Chester, UK
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Affiliation(s)
- Paul Lee
- Medical Devices Training Manager, Abertawe Bro Morgannwg University Local Health Board, Swansea
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8
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McAtamney D, Campbell J. Intravenous extension lines and the potential for residual drug administration. Anaesthesia 2014; 70:115-6. [DOI: 10.1111/anae.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. McAtamney
- Royal Victoria Hospital; Belfast Northern Ireland
| | - J. Campbell
- Craigavon Area Hospital; Portadown Northern Ireland
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9
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Abstracts of the Royal College of Anaesthetists Annual Congress 2014. Br J Anaesth 2014. [DOI: 10.1093/bja/aeu197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Thomas AN, Taylor RJ. An analysis of patient safety incidents associated with medications reported from critical care units in the North West of England between 2009 and 2012. Anaesthesia 2014; 69:735-45. [PMID: 24810765 DOI: 10.1111/anae.12670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
Abstract
Incident reporting is promoted as a key tool for improving patient safety in healthcare. We analysed 2238 patient safety incidents involving medications submitted from up to 29 critical care units each year in the North West of England between 2009 and 2012; 452 (20%) of these incidents led to harm to patients. Although 1461 (65%) incidents were judged to have been preventable, there was no reduction in the rate of incidents per 1000 days between 2009 and 2012 (5.9 in 2009, 6.6 in 2012). Furthermore, in the 2012 data, there were wide variations in the incident rates between units, the median (IQR [range]) rate per 1000 patient days for individual units being 6.8 (3.8-11.0 [1.3-37.1]). The variation in the percentage that could have been avoided was narrower, with a median (IQR [range]) of 70% (61-80% [38-100%]). The most commonly reported drugs were noradrenaline (161 incidents, 92 with harm), heparins (153 incidents, 29 with harm), morphine (131 incidents, 14 with harm) and insulin (111 incidents, 54 with harm). The administration of drugs was the stage in the process where incidents were most commonly reported; it was also the stage most likely to harm patients. We conclude that the wide range in reported rates between units, and the scope for preventing many incidents, suggest that quality improvement initiatives could improve medication safety in the units studied.
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Affiliation(s)
- A N Thomas
- Salford Royal NHS Foundation Trust, Salford, UK
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11
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Norman B. Transient paralysis after cyclizine administration. Anaesthesia 2013; 68:1284. [DOI: 10.1111/anae.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B. Norman
- Chelsea and Westminster Hospital; London UK
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12
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McDevitt L. A reply. Anaesthesia 2013; 68:1285. [DOI: 10.1111/anae.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Dias J, Lages N, Marinho A, Maria L, Tinoco J, Vieira D, Correia C. Accidental spinal potassium chloride injection successfully treated with spinal lavage. Anaesthesia 2013; 69:72-6. [DOI: 10.1111/anae.12486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Affiliation(s)
- J. Dias
- Anaesthesia Service; Centro Hospitalar Do Alto Ave; Guimarães Portugal
| | - N. Lages
- Anaesthesia Service; Centro Hospitalar Do Alto Ave; Guimarães Portugal
| | - A. Marinho
- Anaesthesia Service; Centro Hospitalar Do Alto Ave; Guimarães Portugal
| | - L. Maria
- Anaesthesia Service; Centro Hospitalar Do Alto Ave; Guimarães Portugal
| | - J. Tinoco
- Anaesthesia Service; Centro Hospitalar Do Alto Ave; Guimarães Portugal
| | - D. Vieira
- Anaesthesia Service; Centro Hospitalar Do Alto Ave; Guimarães Portugal
| | - C. Correia
- Anaesthesia Service; Centro Hospitalar Do Alto Ave; Guimarães Portugal
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Wojcikiewicz TGJ, Peck MJE. Transient paralysis after cyclizine administration. Anaesthesia 2013; 68:1284-5. [DOI: 10.1111/anae.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Levine DM, Garden AL, Truong HT, Bergemann J, Eames P. Influence of multi-lumen extensions on fluid flow through intravenous cannulae. Anaesthesia 2013; 68:1239-42. [DOI: 10.1111/anae.12443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- D. M. Levine
- Wellington Regional Hospital; Wellington New Zealand
| | - A. L. Garden
- Wellington Regional Hospital; Wellington New Zealand
| | - H. T. Truong
- Wellington Regional Hospital; Wellington New Zealand
| | - J. Bergemann
- Wellington Regional Hospital; Wellington New Zealand
| | - P. Eames
- Hutt Hospital; Lower Hutt New Zealand
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Affiliation(s)
- A Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK.
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Oglesby KJ, Cook TM, Jordan L. Residual anaesthesia drugs - silent threat, visible solutions. Anaesthesia 2013; 68:981-2. [DOI: 10.1111/anae.12370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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