State Claims Agency reviews clinical incidents

Medicine, maternity, surgery, disability, and older persons were the most common services in our hospitals in which clinical incidents were identified in a five-year look-back by the State Claims Agency.

State Claims Agency reviews clinical incidents

Maternity was the second most common service to report clinical incidents (almost 47,000) of which 405 were rated ‘extreme’, meaning they resulted either in death or permanent incapacity. Among the more common clinical incidents were post-partum haemorrhage and perineal tear.

Almost 70,000 incidents related to medicine. Eight areas were analysed in detail including emergency medicine, mental health, radiology, cardiology, respiratory, gastroenterology, neurology, and infectious diseases.

In relation to emergency medicine the number of clinical incidents identified increased by almost 1,000 between 2010 and 2014. During this time, 290 were rated as ‘extreme’.

Incidents related to delays were prominent, including delay or failure to treat leading to an adverse outcome.

Incidents pertaining to ‘diagnosis’, including delayed diagnosis and failure to diagnose, featured in the 10 most common clinical incidents in emergency medicine nationally over this period. The cost of finalised claims in emergency medicine in 2014 was €12.6m, with an average cost per claim of €395,035.

The figures are contained in National Clinical Incidents, Claims and Costs 2010-2014, published yesterday by the agency. Commenting on the emergency medicine findings, the authors said working in the emergency department “presents specific challenges”.

“These include the clinical working environment, regular overcrowding and shortage of space within which to examine patients and a mix of both medical and surgical emergencies,” said the authors of the report.

Their findings are consistent with a previous study of finalised claims in emergency medicine which identified that errors that led to claims “appeared, in retrospect, to have been simple errors in history-taking, physical examination, communication, and interpretation of radiographs”.

“The authors advised that non-consultant hospital doctors employed in the emergency department need careful supervision with access to senior medical advice,” the agency said.

The agency look-back also found that the clinical claim rate nationally increased from 10 to 13 per 100,000 population, between 2010 and 2014. A peak in 2012 of 17 per 100,000 “is largely explained by mass actions including DePuy hip replacement, the Lourdes Redress scheme [hysterectomies] and symphysiotomies”, they said.

Claims related to diagnosis, including the categories of delayed diagnosis and failure to diagnose, were relatively frequent and combined, accounted for 19% of the 10 most common clinical claims. The authors said hospital-related deaths, reported to the coroner, “represent a small but relevant proportion of clinical claims in some specialities reviewed, namely, emergency medicine, cardiology, gastroenterology and respiratory medicine”.

In gastroenterology, 21 incidents were rated ‘extreme’; 17 were rated ‘extreme’ in respiratory medicine; and 50 in cardiology. Agency director Ciaran Breen said clinical incidents in hospitals “range across a spectrum to include deeply tragic events, involving loss of life or serious injury, to administrative errors and equipment malfunctions”.

“Reducing the number of clinical incidents and improving patient safety is a goal shared by all,” he said. “This report aims to help achieve this goal by identifying adverse clinical incidents’ trends and focusing on areas for improvement.”

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