Medical accidents: research in the U.K

Taking action against medical accidents: A brief history of AvMA and clinical risk management in the NHS

Established in 1982, Action against Medical Accidents (AvMA)-originally named Action for Victims of Medical Accidents-was effectively the first charity in Britain dedicated to 'patient safety'. This article provides a historical analysis of the origins and work of AvMA, situating its background in the medical negligence 'crisis' of the 1970s and 1980s, growing consumerism in healthcare, and the significant barriers to justice patients confronted following a clinical incident. It also explores AvMA's impacts on evolving attitudes towards patient harm and safety in the NHS. The article asserts that in addition to supporting patients and campaigning for changes in legal procedures, AvMA played an instrumental role in raising the political profile of adverse health events ('medical accidents'). By supporting claimant solicitors and increasing their chances of legal success, AvMA contributed to the rising tide of negligence claims, which incentivised NHS trusts and health authorities to introduce clinical risk management (CRM). By 2000, CRM was being framed as part of a broader mission to improve quality and safety in healthcare, and AvMA was recognised as a key stakeholder in the new patient safety agenda.

Doctors' perceptions of the links between stress and lowered clinical care

We know from numerous industrial studies that stress, particularly in the form of tiredness and sleep deprivation, has a detrimental effect upon work performance, though this is not so clear-cut in studies of doctors, despite their stress levels being particularly high. This study explores the doctors' views on this using anonymous questionnaires from a population of 225 hospital doctors and general practitioners, 82 of whom reported recent incidents where they considered that symptoms of stress had negatively affected their patient care. The qualitative accounts they gave were coded for the attribution (type of stress symptom) made, and the effect it had. Half of these effects concerned lowered standards of care; 40% were the expression of irritability or anger; 7% were serious mistakes which still avoided directly leading to death; and two resulted in patient death. The attributions given for these were largely to do with tiredness (57%) and the pressure of overwork (28%), followed by depression or anxiety (8%), and the effects of alcohol (5%). The data are discussed in terms of the links made by the doctors between their fatigue or work pressure and the way they care for patients. It presumes that these incidents had been previously unreported and talks about the effects this secrecy has on the emotional state of the doctors concerned. It offers ways forward for tackling the problem, of interest to the profession, managers and commissioners.

Mortality associated with anaesthesia. A case review study

The review is based on an analysis of anonymous case record material at the Medical Protection Society's London Office for the 5-year period 1982-1986, in which death was associated with anaesthetic procedures. A total of 25 cases were analysed. The principal events which resulted in death were failed intubation, drug-related problems and problems with equipment. The principal contributory factors were inadequate supervision, inadequate pre-operative assessment and failure of communication. The present review suggests that supervision and training of junior staff, decision-making by senior staff and patterns of communication both within and between specialties are areas which should be selected for further research.