Litigation in breast surgery: unique insights from the English National Health Service experience.
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
07 05 2021
07 05 2021
Historique:
received:
19
11
2020
accepted:
09
12
2020
entrez:
11
5
2021
pubmed:
12
5
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
The increase in medical negligence claims against the National Health Service (NHS) over the past decade has had a detrimental impact on limited financial and human resources that could otherwise be available for direct clinical care. The aim of this study was to review litigation claims in breast surgery as part of the national Getting It Right First Time quality improvement initiative, with the aim of identifying opportunities to improve clinical practice and patient safety. All general and plastic surgical claims notified to NHS Resolution between April 2012 and April 2018 were reviewed. Claims related specifically to breast surgery were retrieved manually, and case summaries were analysed independently by two breast surgeons. From 6915 claims, 449 relating to breast surgery were identified and reviewed. The mean(s.d.) claimant age was 46(13) years. The median number of claims over the 6-year period per NHS trust was 2 (range 0-22). The most frequent causes of litigation were dissatisfaction with cosmetic outcome (121 claims, 26.9 per cent) and patient-reported delays in diagnosis (121, 26.9 per cent). A large proportion of claims related to breast implant surgery (78, 17.4 per cent), and issues regarding consent/communication were common (69, 15.4 per cent). The estimated annual cost of breast surgery litigation claims ranged from £5.57 to £9.59 million (€6.35-11.02 million). Patient-reported delays in diagnosis and dissatisfaction with cosmetic outcome are the most common causes of litigation related to breast surgery. These key themes should be the focus for workforce learning, with the aim of improving patient care and experience.
Sections du résumé
BACKGROUND
The increase in medical negligence claims against the National Health Service (NHS) over the past decade has had a detrimental impact on limited financial and human resources that could otherwise be available for direct clinical care. The aim of this study was to review litigation claims in breast surgery as part of the national Getting It Right First Time quality improvement initiative, with the aim of identifying opportunities to improve clinical practice and patient safety.
METHODS
All general and plastic surgical claims notified to NHS Resolution between April 2012 and April 2018 were reviewed. Claims related specifically to breast surgery were retrieved manually, and case summaries were analysed independently by two breast surgeons.
RESULTS
From 6915 claims, 449 relating to breast surgery were identified and reviewed. The mean(s.d.) claimant age was 46(13) years. The median number of claims over the 6-year period per NHS trust was 2 (range 0-22). The most frequent causes of litigation were dissatisfaction with cosmetic outcome (121 claims, 26.9 per cent) and patient-reported delays in diagnosis (121, 26.9 per cent). A large proportion of claims related to breast implant surgery (78, 17.4 per cent), and issues regarding consent/communication were common (69, 15.4 per cent). The estimated annual cost of breast surgery litigation claims ranged from £5.57 to £9.59 million (€6.35-11.02 million).
CONCLUSION
Patient-reported delays in diagnosis and dissatisfaction with cosmetic outcome are the most common causes of litigation related to breast surgery. These key themes should be the focus for workforce learning, with the aim of improving patient care and experience.
Identifiants
pubmed: 33972991
pii: 6273346
doi: 10.1093/bjsopen/zraa068
pmc: PMC8110893
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
Références
J Natl Cancer Inst. 2018 Feb 1;110(2):
pubmed: 28954300
N Engl J Med. 2009 Jan 29;360(5):491-9
pubmed: 19144931
West J Med. 2000 Jun;172(6):393-6
pubmed: 10854390
Eur J Surg Oncol. 1999 Dec;25(6):571-3
pubmed: 10556001
Ann R Coll Surg Engl. 2011 May;93(4):273-4
pubmed: 22043493
Radiother Oncol. 1992 Nov;25(3):153-9
pubmed: 1470691
Patient Educ Couns. 2020 Apr;103(4):833-838
pubmed: 31813712
Breast. 2013 Oct;22(5):964-7
pubmed: 23756382
Arch Plast Surg. 2015 Jan;42(1):4-10
pubmed: 25606483
Surgeon. 2018 Feb;16(1):27-35
pubmed: 27161098
Breast. 2010 Dec;19(6):470-4
pubmed: 20627726
Ann Surg. 2019 Sep;270(3):473-483
pubmed: 31356276
BMJ Qual Saf. 2014 Apr;23(4):299-318
pubmed: 23922403
J Epidemiol Community Health. 1999 Nov;53(11):716-20
pubmed: 10656101
Clin Imaging. 2020 Mar;60(1):26-32
pubmed: 31864196
J Clin Oncol. 2008 Jul 10;26(20):3331-7
pubmed: 18612149
Breast. 2019 Aug;46:1-3
pubmed: 30981031
Lancet Oncol. 2019 Feb;20(2):254-266
pubmed: 30639093
Ann Surg Oncol. 2018 Oct;25(10):2939-2947
pubmed: 29956091
Lancet. 2018 Jul 14;392(10142):102-104
pubmed: 30017115
Breast. 2008 Apr;17(2):148-51
pubmed: 17890087