Navaratnam Annakan Victor, Hariri Ahmad, Ho Cherrie, Machin John T, Briggs Tim Wr, Marshall Andrew
Getting it Right First Time Programme, NHS England & NHS Improvement, London, UK.
Royal National Throat, Nose and Ear Hospital, University College London Healthcare NHS Trust, London, UK.
Clin Otolaryngol. 2021 Jan;46(1):9-15. doi: 10.1111/coa.13646. Epub 2020 Oct 2.
Litigation against the National Health Service (NHS) in England is rising. The aim of this study was to determine the incidence and characteristics of otorhinolaryngology clinical negligence claims in England.
A retrospective review was undertaken of all clinical negligence claims in England held by NHS Resolution relating to otorhinolaryngology between April 2013 and April 2018. Analysis was performed using information for cause, patient injury and claim cost. Where claim information was adequately detailed, the authors categorised claims by subspecialty, diagnosis and surgery.
A total number of 727 claims were identified with an estimated potential cost of £108 million. Out of these, 463 were closed claims. Including open claim reserves, the mean cost of a claim was £148 923. Head and neck surgery was the subspecialty with the highest number of claims (n = 313, 43%) and highest cost (£51.5 million) followed by otology (n = 171, £24.5 million) and rhinology (n = 171, £13.6 million). Over half of claims were associated with an operation (n = 429, 59%) where mastoid surgery (n = 46) and endoscopic sinus surgery (n = 46) were equally associated with the greatest number of claims. The most frequent causes for clinical negligence claims included failure or delay to diagnose (n = 178, 25%), failure or delay to treat (n = 136, 19%), intra-operative complications (n = 130, 18%) and failure of the consent process (n = 107, 15%).
Clinical negligence claims in otorhinolaryngology are related to several different components of patient management and are not limited to postoperative complications. This study highlights the importance of robust pathways in out-patient diagnostics and the consenting process in order to deliver better patient care and reduce the impact of litigation. Keywords informed consent, malpractice, clinical negligence claims, litigation, otolaryngology.
针对英国国民医疗服务体系（NHS）的诉讼案件数量正在上升。本研究旨在确定英格兰耳鼻喉科临床过失索赔的发生率及特点。
对NHS Resolution在2013年4月至2018年4月期间受理的英格兰所有与耳鼻喉科相关的临床过失索赔进行回顾性研究。利用索赔原因、患者损伤及索赔费用等信息进行分析。在索赔信息足够详细的情况下，作者按亚专业、诊断及手术对索赔进行分类。
共识别出727起索赔，估计潜在费用为1.08亿英镑。其中，463起为已结案索赔。包括未结案索赔储备金在内，平均每起索赔费用为148,923英镑。头颈外科是索赔数量最多（n = 313，43%）且费用最高（5150万英镑）的亚专业，其次是耳科学（n = 171，2450万英镑）和鼻科学（n = 171，1360万英镑）。超过半数的索赔与手术相关（n = 429，59%），其中乳突手术（n = 46）和鼻内镜手术（n = 46）引发的索赔数量最多。临床过失索赔最常见的原因包括诊断失败或延误（n = 178，25%）、治疗失败或延误（n = 136，19%）、术中并发症（n = 130，18%）以及同意程序失败（n = 107，15%）。
耳鼻喉科临床过失索赔与患者管理的多个不同环节相关，并不局限于术后并发症。本研究强调了在门诊诊断及同意程序中建立完善流程的重要性，以便提供更好的患者护理并减少诉讼影响。关键词知情同意、医疗事故、临床过失索赔、诉讼、耳鼻喉科
