Clinical Risk Unit, State Claims Agency, Dublin, Ireland
Clinical Risk Unit, State Claims Agency, Dublin, Ireland.
BMJ Open Qual. 2024 Sep 3;13(3):e002688. doi: 10.1136/bmjoq-2023-002688.
Learning from adverse outcomes in health and social care is critical to advancing a culture of patient safety and reducing the likelihood of future preventable harm to service users. This review aims to present an overview of all clinical claims finalised in one calendar year involving publicly funded health and social care providers in Ireland.
This is a retrospective observational study. The Clinical Risk Unit (CRU) of the State Claims Agency identified all service-user clinical claims finalised between 1 January 2017 and 31 December 2017 from Ireland's National Incident Management System (n=713). Claims that had incurred financial damages were considered for further analysis (n=356). 202 claims underwent an in-depth qualitative review. Of these, 57 related to maternity and gynaecology, 64 to surgery, 46 to medicine, 20 to community health and social care and 15 related to children's healthcare.
The services of surgery and medicine ranked first and second, respectively, in terms of a number of claims. Claims in maternity services, despite ranking third in terms of claims numbers, resulted in the highest claims costs. Catastrophic injuries in babies resulting in cerebral palsy or other brain injury accounted for the majority of this cost.Diagnostic errors and inadequate or substandard communication, either with service users and/or interprofessional communication with colleagues, emerged as common issues across all clinical areas analysed. Quantitative analysis of contributory factors demonstrated that the complexity and seriousness of the service user's condition was a significant contributory factor in the occurrence of incidents leading to claims.
This national report identifies common issues resulting in claims. Targeting these issues could mitigate patient safety risks and reduce the cost of claims.
从医疗保健中的不良结果中学习对于推进患者安全文化和降低服务使用者未来可预防伤害的可能性至关重要。本综述旨在概述在爱尔兰一个日历年内完成的所有涉及公共资助的医疗保健提供者的临床索赔。
这是一项回顾性观察研究。国家索赔局的临床风险股（CRU）从爱尔兰国家事件管理系统（n=713）中确定了 2017 年 1 月 1 日至 12 月 31 日期间完成的所有服务使用者临床索赔。考虑对发生财务损失的索赔进行进一步分析（n=356）。202 项索赔进行了深入的定性审查。其中，57 项与妇产科有关，64 项与外科有关，46 项与内科有关，20 项与社区卫生和社会护理有关，15 项与儿童保健有关。
就索赔数量而言，外科和内科服务分别排名第一和第二。尽管妇产科服务在索赔数量方面排名第三，但索赔费用最高。导致脑瘫或其他脑损伤的婴儿灾难性损伤占此费用的大部分。在所有分析的临床领域中，诊断错误和与服务使用者沟通不足或沟通不佳以及与同事的跨专业沟通均是常见问题。对促成因素的定量分析表明，服务使用者病情的复杂性和严重性是导致导致索赔的事件发生的重要促成因素。
本国家报告确定了导致索赔的常见问题。针对这些问题可以降低患者安全风险并降低索赔成本。
