An audit of litigation costs in four accident and emergency departments.

Hulbert, Diana; Riddle, W L; Longstaff, P M; Belstead, J; Beckett, M W

doi:10.1136/emj.13.6.400

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…6 Missed fractures are a very common cause of litigation in emergency medicine. 7 For these reasons it has become standard practice for all ED radiographs to be formally reported by a radiologist, and this policy is supported by the Royal College of Radiologists. 8 Nevertheless, the formal reporting of all ED radiographs is a time consuming and generally unpopular radiological activity.…”

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confidence: 99%

What is the effect of reporting all emergency department radiographs?

Benger

2003

Emergency Medicine Journal

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Objectives: To evaluate the effect of formal radiological reporting of all emergency department (ED) radiographs on clinical practice and patient outcome, and to consider whether a selective reporting policy might prove safe and effective. Methods: All radiographs taken in a single ED over a six month period were prospectively studied simultaneously in both the emergency and radiology departments to detect cases where a radiograph that was considered normal by ED staff was then reported as abnormal by the reporting radiologist. Whenever such a discrepancy occurred the patient's records were scrutinised to ascertain the source of the discrepancy, with a gold standard interpretation derived from senior clinical review and additional investigations where indicated. The clinical impact of the radiologist's formal report was then assessed. Accuracy of interpretation was considered in relation to the grade of ED staff and the radiographic examination obtained. Results: During the study period, 19 468 new patient attendances to the ED generated 11 749 radiographic examinations. Discrepancies were detected in 175 patients (1.5% of all radiographic examinations). Of these, 136 (1.2%) were subsequently shown to have been incorrectly interpreted in the ED (ED false negatives), with 40 patients (0.3%) undergoing a change in management as a result. In the remaining 39 the ED interpretation was judged to be correct (radiology false positives), with 16 patients undergoing further investigations or visits to the ED to confirm this. Conclusions: The formal reporting of ED radiographs by the radiology department detects a number of clinically important abnormalities that have been overlooked. However, this formal reporting also generates a number of incorrect interpretations that may lead to further unnecessary investigations. Some groups of ED radiographs (such as those interpreted by an ED consultant and films of the fingers and toes) may not require formal radiological reporting. The adoption of a selective reporting policy may reduce the reporting workload of the radiology department without compromising patient care.

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confidence: 99%

What is the effect of reporting all emergency department radiographs?

Benger

2003

Emergency Medicine Journal

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“…It is difficult to quantify the rate at which healthcare systems are justified in accepting the failure to detect findings. Certainly, false negatives are likely to represent the most deleterious of these errors; borne-out by the evidence on litigation for missed fractures both in the UK [ 6 , 22 ] and abroad [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Reporting errors in plain radiographs for lower limb trauma—a systematic review and meta-analysis

York

Franklin²,

Reynolds³

et al. 2021

Skeletal Radiol

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Introduction Plain radiographs are a globally ubiquitous means of investigation for injuries to the musculoskeletal system. Despite this, initial interpretation remains a challenge and inaccuracies give rise to adverse sequelae for patients and healthcare providers alike. This study sought to address the limited, existing meta-analytic research on the initial reporting of radiographs for skeletal trauma, with specific regard to diagnostic accuracy of the most commonly injured region of the appendicular skeleton, the lower limb. Method A prospectively registered, systematic review and meta-analysis was performed using published research from the major clinical-science databases. Studies identified as appropriate for inclusion underwent methodological quality and risk of bias analysis. Meta-analysis was then performed to establish summary rates for specificity and sensitivity of diagnostic accuracy, including covariates by anatomical site, using HSROC and bivariate models. Results A total of 3887 articles were screened, with 10 identified as suitable for analysis based on the eligibility criteria. Sensitivity and specificity across the studies were 93.5% and 89.7% respectively. Compared with other anatomical subdivisions, interpretation of ankle radiographs yielded the highest sensitivity and specificity, with values of 98.1% and 94.6% respectively, and a diagnostic odds ratio of 929.97. Conclusion Interpretation of lower limb skeletal radiographs operates at a reasonably high degree of sensitivity and specificity. However, one in twenty true positives is missed on initial radiographic interpretation and safety netting systems need to be established to address this. Virtual fracture clinic reviews and teleradiology services in conjunction with novel technology will likely be crucial in these circumstances.

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“…Society is less tolerant of mistakes or inadequate service and litigation claims are now becoming increasingly accepted. Much media attention often accompanies high profile claims against NHS organisations and there is evidence in the literature of claims against all hospital specialities including emergency medicine 3 4. Although less, if anything, has been written about claims against the ambulance service in the United Kingdom, litigation appears to be expanding into the area of pre-hospital care.…”

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confidence: 99%

A descriptive review and discussion of litigation claims against ambulance services

Dobbie

Cooke

2008

Emergency Medicine Journal

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This study suggests that the key clinical areas that need to be addressed are obstetric care, spinal injury recognition and the decision not to convey a person to hospital. The first two of these have been addressed in the recent release of the Joint Royal Colleges Ambulance Liaison Committee guidelines. The major areas of organisation relate to reducing delays and providing the safe transfer of patients.

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An audit of litigation costs in four accident and emergency departments.

Cited by 8 publications

References 4 publications

What is the effect of reporting all emergency department radiographs?

What is the effect of reporting all emergency department radiographs?

Reporting errors in plain radiographs for lower limb trauma—a systematic review and meta-analysis

A descriptive review and discussion of litigation claims against ambulance services

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