Department of Breast Surgery, Royal Marsden NHS Foundation Trust, London, UK.
Department of Breast Surgery, University College Hospital, London, UK.
BJS Open. 2021 May 7;5(3). doi: 10.1093/bjsopen/zraa068.
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.
在过去十年中，针对国民保健制度（NHS）的医疗疏忽索赔有所增加，这对本可用于直接临床护理的有限财务和人力资源产生了不利影响。本研究旨在审查乳房手术中的诉讼索赔，作为国家“首次正确完成”质量改进计划的一部分，旨在确定改善临床实践和患者安全的机会。
审查了 NHS Resolution 在 2012 年 4 月至 2018 年 4 月期间收到的所有普通和整形外科索赔。手动检索专门与乳房手术有关的索赔，两名乳房外科医生独立分析案例摘要。
从 6915 件索赔中，确定并审查了 449 件与乳房手术有关的索赔。索赔人平均（标准差）年龄为 46（13）岁。在 6 年期间，每个 NHS 信托机构的索赔中位数为 2（范围 0-22）。诉讼的最常见原因是对美容效果不满意（121 起索赔，占 26.9%）和患者报告的诊断延误（121 起，占 26.9%）。很大一部分索赔与乳房植入手术有关（78 起，占 17.4%），与同意/沟通有关的问题很常见（69 起，占 15.4%）。乳房手术诉讼索赔的估计年费用范围为 557 万至 959 万英镑（635 万至 1102 万欧元）。
患者报告的诊断延误和对美容效果不满意是与乳房手术相关的诉讼的最常见原因。这些关键主题应成为劳动力学习的重点，旨在改善患者护理和体验。
