Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS

Machin, John T; Hardman, John; Harrison, W. D.; Briggs, Timothy; Hutton, Mike

doi:10.1007/s00586-018-5739-1

Cited by 43 publications

(34 citation statements)

References 6 publications

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“…Between 2013 and 2016, there were 131 claims relating to CES in the UK, with a projected value of 68 million. 34 These were most commonly due to delay in diagnosis or treatment. 34 In the US, the average payout of 15 lawsuits related to CES between 1983 and 2010 was $1.57 million.…”

Section: Discussionmentioning

confidence: 99%

“…34 These were most commonly due to delay in diagnosis or treatment. 34 In the US, the average payout of 15 lawsuits related to CES between 1983 and 2010 was $1.57 million. 12 It is unknown whether the frequency of legal action for CES in a country is associated with the clinical threshold for investigation of symptoms with an MRI study, as all but one study of patients with suspected CES were carried out in the UK.…”

Section: Discussionmentioning

confidence: 99%

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What is the incidence of cauda equina syndrome? A systematic review

Hoeritzauer

Wood

Copley

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVECauda equina syndrome (CES) is a surgical emergency requiring timely operative intervention to prevent symptom progression. Accurately establishing the incidence of CES is required to inform healthcare service design and delivery, including out-of-hours imaging arrangements.METHODSA systematic literature search of MEDLINE, EMBASE, and Scopus was undertaken to identify original studies stating the incidence of CES, and the estimates were combined in a meta-analysis as described in the protocol registered with PROSPERO (registration no. CRD42017065865) and reported using the PRISMA guidelines.RESULTSA total of 1281 studies were identified, and 26 studies were included in the review. Data about CES incidence were available from 3 different populations: asymptomatic community populations, patients with nontraumatic low-back pain, and patients presenting as an emergency with suspected CES. The incidence of CES was 0.3–0.5 per 100,000 per year in 2 asymptomatic community populations, 0.6 per 100,000 per year in an asymptomatic adult population, and 7 per 100,000 per year in an asymptomatic working-age population. CES occurred in 0.08% of those with low-back pain presenting to primary care in 1 study, and a combined estimate of 0.27% was calculated for 4 studies of those with low-back pain presenting to secondary care. Across 18 studies of adults with suspected CES, 19% had radiological and clinical CES. Difficulties in comparison between studies resulted from the heterogeneous definitions of CES and lack of separation of more advanced CES with retention, which is unlikely to be reversible. In the studies of patients with suspected CES, the small sample size, the high number of single-center studies (18/18), the high number of studies from the United Kingdom (17/18), the retrospective nature of the studies, and the high number of abstracts rather than full texts (9/18) reduced the quality of the data.CONCLUSIONSFrom current studies, it appears that CES occurs infrequently in asymptomatic community populations and in only 19% of those presenting with symptoms. Determining accurate incidence figures and designing a bespoke service for investigation of patients with suspected CES would require a consensus clinical and radiological definition of CES and international multisite studies of patient pathways of investigation and management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What is the incidence of cauda equina syndrome? A systematic review

Hoeritzauer

Wood

Copley

et al. 2020

Journal of Neurosurgery: Spine

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“…The clinical litigation crisis poses a real and perhaps not widely recognised threat to the sustainability of the NHS—many clinicians, for example, are unaware of negligence claims in their own hospital 50. The four principles we have identified are supported by evidence, but, as in other countries, the benefits have been missed as a result of poor implementation 51.…”

Section: Discussionmentioning

confidence: 86%

Clinical negligence costs: taking action to safeguard NHS sustainability

Yau

Leigh²,

Liberati

et al. 2020

BMJ

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Spending on clinical negligence is escalating, constituting a major threat to the sustainability of the NHS In England, payments for negligence awards are resourced from the same funds used to provide care Improvements in quality and patient safety might help to reduce litigation costs but need to be evidence based Solving the crisis in litigation costs will require a system-wide effort, with engagement and coordination of stakeholders across the health system

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“…20 Other studies determined that a lack of informed consent was the third most common reason for litigation, 11,13,14 while others found that litigation on grounds of lack of informed consent was less common. 12,26 One study found that a lack of informed consent was implicated in cranial cases more often than in spinal cases. 13 Median or mean payments were greater for plaintiff verdicts than for the settlements for spine surgery malpractice cases, 11,14 whereas payments for settlements were greater than those for plaintiff verdicts for endoscopic sinus surgery.…”

Section: Medicolegal Implications Of Informed Consentmentioning

confidence: 99%

“…12 Four studies examined spine surgery. 11,14,16,26 One of them determined that a lack of informed consent was the reason for the lawsuit in 42.6% of cases involving quadriplegia after cervical spine surgery in the United States, behind negligent surgery at 87.0% of cases and failure to diagnose or treat at 61.1% of cases, with total mean payments of $5.9 million for plaintiff verdicts and $2.8 million for settlements. 14 Another study found that a lack of informed consent was a factor in 24.4% of all spine surgery malpractice cases, as compared to a failure to diagnose at 31.6% of cases and a failure to treat at 32.7% of cases, with total median payments of $2.5 million for plaintiff verdicts and $1.3 million for settlements.…”

Section: Medicolegal Implications Of Informed Consentmentioning

confidence: 99%

Informed consent in neurosurgery: a systematic review

Shlobin

Sheldon²,

Lam

2020

Neurosurgical Focus

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OBJECTIVEInformed consent has served as a main principle of medical ethics and laws in the United States. The 1986 American Association of Neurological Surgeons Code of Ethics implied medicolegal liability for the failure to obtain informed consent without providing practical guidance regarding the application of informed consent to individual patient encounters in a medicolegal environment. Here, the authors aimed to identify baseline patient recall after discussions with neurosurgeons and their capacity to provide informed consent, describe the effects of interventions to improve patient comprehension, and elucidate the role of informed consent in malpractice litigation in neurosurgery. Their findings may guide neurosurgeons in discussions to properly inform patients and reduce the risk of litigation.METHODSA systematic review was conducted to explore informed consent within neurosurgery and its application to medicolegal liability using the PubMed, Embase, and Scopus databases. Titles and abstracts from articles identified in the search were read and selected for full-text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.RESULTSOf 1428 resultant articles, 21 were included in the review. Baseline patient recall was low, particularly for risks and alternatives of treatments, and even decreased over time. Cognitive impairment was noted as a factor limiting the ability to provide informed consent. Interventions incorporating a combination of modalities in informed consent discussions, a specialized consent form with points for neurosurgeons to check off upon discussion, interactive websites, question prompt lists, and illustrations were found to be effective in improving patient knowledge. Lack of informed consent was a common factor for malpractice litigation. Spine surgery was particularly prone to costly lawsuits. Payments were generally greater for plaintiff verdicts than for settlements.CONCLUSIONSThe application of informed consent to patient encounters is an important facet of clinical practice. Neurosurgeons have a duty to provide patients with all pertinent information to allow them to make decisions about their care. The authors examined baseline patient comprehension and capacity, interventions to improve informed consent, and malpractice litigation; it appears that determining the proper capacity to provide informed consent and considering informed consent as a process that depends on the setting are important. There is room to improve the informed consent process centered on baseline patient health literacy and understanding as well as clear communication using multiple modalities.

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Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS

Cited by 43 publications

References 6 publications

What is the incidence of cauda equina syndrome? A systematic review

What is the incidence of cauda equina syndrome? A systematic review

Clinical negligence costs: taking action to safeguard NHS sustainability

Informed consent in neurosurgery: a systematic review

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