Otolaryngology litigation in England: 727 clinical negligence cases against the NHS

Navaratnam, Annakan; Hariri, Ahmad; Ho, Cherrie; Machin, John T; Marshall, Andrew; Briggs, Tim

doi:10.22541/au.159256281.16465674

Cited by 4 publications

(5 citation statements)

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“…During this 5-year period, otology and rhinology had an equal number of clinical negligence claims ( n = 171), but otology had estimated potential clinical negligence costs that were nearly 50 per cent higher than rhinology (rhinology related claims were valued at £13.6 million). 11…”

Section: Discussionmentioning

confidence: 99%

What can be learned from litigation in otology? A review of clinical negligence claims in England 2013–2018

McClenaghan

Ho²,

Machin³

et al. 2021

J. Laryngol. Otol.

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Background Litigation in the National Health Service continues to rise with a 9.4 per cent increase in clinical negligence claims from the period 2018 and 2019 to the period 2019 and 2020. The cost of these claims now accounts for 1.8 per cent of the National Health Service 2019 to 2020 budget. This study aimed to identify the characteristics of clinical negligence claims in the subspecialty of otology. Methods This study was a retrospective review of all clinical negligence claims in otology in England held by National Health Service Resolution between April 2013 and April 2018. Results There were 171 claims in otology, 24 per cent of all otolaryngology claims, with a potential cost of £24.5 million. Over half of these were associated with hearing loss. Stapedectomy was the highest mean cost per claim operation at £769 438. The most common reasons for litigation were failure or delay in treatment (23 per cent), failure or delay in diagnosis (20 per cent), intra-operative complications (15 per cent) and inadequate consent (13 per cent). Conclusion There is a risk of high-cost claims in otology, especially with objective injuries such as hearing loss and facial nerve injury.

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Section: Discussionmentioning

confidence: 99%

What can be learned from litigation in otology? A review of clinical negligence claims in England 2013–2018

McClenaghan

Ho²,

Machin³

et al. 2021

J. Laryngol. Otol.

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“…17 However, tonsillectomy has been found to be one of the top three highest otorhinolaryngology procedures associated with negligence claims in the National Health Service (NHS) in England; 15 per cent of claims in this study were attributed to fault in the consent process, highlighting a shortcoming at the clinician's end. 18 Since 2015, following the ruling from Montgomery versus Lanarkshire Health Board, a clash has existed between medical paternalism and patient autonomy. 19 In this case, the test of materiality was introduced; this requires the surgeon to consider whether a reasonable person in the patient's position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would likely attach significance to it.…”

Section: Discussionmentioning

confidence: 99%

What the blogosphere has to say about adult tonsillectomy

2021

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Objectives Tonsillectomy has generated extensive comment on the internet, but this content has not been examined in a scientific manner. This study aimed to determine what the blogosphere has to say about adult tonsillectomy and to report whether this information can be used to improve post-surgical care. Methods The internet was searched to find personal blogs relating to tonsillectomy. A retrospective review of data collected on these blogs was carried out and the blogs were conceptually analysed by the authors. Results Fifty blogs were included. Seventy per cent of patients had read blogs prior to their procedure. The average pain score where available was 7.2. Complications occurred in 10 per cent of patients. Only 1 patient (2 per cent) regretted having a tonsillectomy. Conclusion It is important for otolaryngologists to stay in tune with the blogosphere as this unregulated and easily accessible source of information is both friend and foe but will ultimately help in pre-operative counselling and post-operative management.

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“…21 Mastoid surgery ranks in the joint highest area of otolaryngology associated with negligence claims. 22 The current guidelines for the completion of training to a consultant level in the UK state a minimum of 10 mastoid operations as principle surgeon; this is the mean number at which trainees become competent at the steps common to all mastoidectomies, and represents a consensus threshold from training programme directors. 23,24 This remains significantly less than the 25 operations associated with a plateau of the learning curve, leaving further training and competence to be attained during independent practice.…”

Section: Discussionmentioning

confidence: 99%

“…21 Mastoid surgery ranks in the joint highest area of otolaryngology associated with negligence claims. 22…”

Section: Discussionmentioning

confidence: 99%

Trainee–trainer outcomes in mastoid surgery: a comparative study

2021

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Background Mastoid exploration remains an advanced, mainstay operation within ENT, in which the surgical trainees’ role has been debated. This audit compares mastoid exploration outcomes between trainees and consultants. Methods Cortical mastoidectomy, atticotomy, atticoantrostomy, modified radical mastoidectomy, combined-approach tympanoplasty and revision mastoidectomy operations performed between 2009 and 2020 were reviewed. Complications assessed were: facial palsy, labyrinth injury, dead ear, disease recurrence and time to recurrence. The chi-square test was used to determine significant associations. Results A total of 118 operations were surveyed. Thirty-five per cent of procedures (n = 41) were performed by trainees under supervision, and 65 per cent (n = 77) were carried out solely by consultants. Patients from 5 per cent of trainees’ operations (n = 2) developed recurrence, compared with 7.8 per cent of consultants’ (n = 6) (p = 0.55). No other complications developed in either group. Conclusion The results corroborate those of other studies, indicating no significant increase in complication rate from consultants to trainees. Trainees likely completed less complicated cases. The stepwise incorporation of trainees did not compromise patient safety.

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Otolaryngology litigation in England: 727 clinical negligence cases against the NHS

Cited by 4 publications

References 0 publications

What can be learned from litigation in otology? A review of clinical negligence claims in England 2013–2018

What can be learned from litigation in otology? A review of clinical negligence claims in England 2013–2018

What the blogosphere has to say about adult tonsillectomy

Trainee–trainer outcomes in mastoid surgery: a comparative study

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