What to do when complications occur

Abstract

Adverse events and complications, even if minor, can result in considerable negative effects on patients, including loss of life. They can also have an impact on the healthcare workers involved. Offering an apology to a patient who has suffered a complication is necessary, and is not an admission of fault. In England and Wales, there are also statutory obligations of candour in cases of more severe notifiable events. Local and national systems exist for incident reporting, with a strong emphasis on learning from events and sharing of best practice. Complaints may arise from poor management of a patient's complications, and in situations where there is a clear breach of a professional duty that has resulted in patient harm, negligence may be deemed to have occurred. National Health Service Resolution focuses on learning from events to help reduce the growth in litigation and emphasises that discussions should be timely, include appropriate explanation and information, and provide ongoing support and, if necessary, continuity of care.

Improper Treatments in the Field of Oral and Maxillofacial Surgery: A Clinical Cohort Study of 55 Cases

“…Patients in this study sought help due to complications caused by improper treatments and their previous issues not improving or worsening. 4,8,10,20,24,25 Referral reasons included malocclusions, orofacial deformities, nerve injuries, facial palsy, limited mouth opening, TMJ dislocations, implant-related issues, postoperative infections, facial abscess, facial emphysema, graft sequestration, orofacial fistulas, mandibular osteonecrosis, pathological fractures, tongue necrosis, and oronasal defects.…”

“…If the physician reaches their limits, they should refer the patient to an expert or a more knowledgeable and experienced colleague and consult when necessary. 4,20,24,25 Some patients in this study were referred by their previous physicians due to unresolved problems. In contrast, others sought help directly due to the previous physicians' lack of responsibility, failure to solve the problems, or even the worsening of the situation.…”

Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery

“…Where emergency haematoma evacuation has taken place, it is important for the surgical team, usually the consultant, to communicate with the patient including after discharge. This should include offering referral for clinical psychology support or similar [ 62 , 63 , 64 , 65 , 66 ] (Grade B). When haematoma has occurred, especially if there has been an airway complication, a duty of candour letter should be sent to the patient describing what has happened and offering ongoing support, when appropriate [ 64 , 65 , 66 ] (Grade B).…”

“…This should include offering referral for clinical psychology support or similar [ 62 , 63 , 64 , 65 , 66 ] (Grade B). When haematoma has occurred, especially if there has been an airway complication, a duty of candour letter should be sent to the patient describing what has happened and offering ongoing support, when appropriate [ 64 , 65 , 66 ] (Grade B). The impact of events on staff must also be considered.…”

Complications: an anaesthetist's rather than a surgeon's notes (with apologies to Atul Gwande)

“…An area that is often overlooked in the published literature is what to do after a complication has occurred, with articles tending to place greater focus on the emergency medical response. Cruikshanks and Bryden provide pause for thought and comprehensive practical advice in their article answering this very question . If we get this right then the outcome for our patients is improved, and our own risk is reduced.…”