SUMMARYA survey of three London hospitals found that approximately 045 patients per thousand new attenders die in the accident and emergency department and that there is evidence of poor management in about 10% of these deaths. The commonest faults were excessive delay before starting appropriate treatment and neglect of the basic principles of emergency medicine. These points need to be emphasized in the training of accident and emergency staff.

Objective-To carry out an audit of cases of litigation relating to accident and emergency departments to determine the outcome and costs to the hospitals involved. Methods-The experience of four similar hospitals was examined over a three year period. All cases which required at least an exchange of solicitors' letters were included. Results-In total 32 claims were made, of which 17 were settled by solicitors' letters, six cases proceeded to court and were lost by the hospital involved, and in nine cases an out-of-court settlement was reached. The costs to the hospitals ranged from £180 to £30 000, with an average cost of £4080. Over the course of the audit the number of cases of litigation remained constant at three per year, while the number of complaints rose threefold to 150. The majority of successful claims concerned missed fractures. Conclusions-Litigation is uncommon and litigation costs reasonable. Given the frequency of missed fractures as a reason for a successful claim, early x ray reporting probably reduces the risk of litigation. (7Accid Emerg Med 1996;13:400-401)

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