Balancing the scales of safety: the criminal law's impact on patient safety and error reduction.

The chance of death from medical error within the hospital setting is 33,000 times greater than dying in an aircraft crash. Despite patient safety being central to healthcare delivery across the world, medical errors and patient harm remain prevalent. This review evaluates the role of the criminal law in regulating healthcare across England and Wales, using prior legal case studies, and focussing on the offence of gross negligence manslaughter (GNM). It further examines the extent to which the law promotes patient safety and minimises fatal errors in healthcare. Medical negligence resulting in a patient's death invokes the more punitive criminal law. In the context of the legal framework in England and Wales, individuals, including medical professionals, who are found to have caused a fatality due to 'gross negligence' may potentially be subject to manslaughter charges. Healthcare delivery is complex as it involves working in high-risk environments, invariably as part of a team. When things go wrong, it is rarely the result of an individual's error but rather a systemic failure. Human factors that may contribute to GNM include organisational influences such as trust targets and pressures to deliver results, unsafe supervision, or inadequate staffing, and preconditions for unsafe acts whereby clinicians are fatigued whilst performing multiple roles simultaneously. A more just culture is warranted in response to the criminalisation of cases of healthcare malpractice, in particular those involving GNM, in which healthcare professionals would be able to learn without fear of retribution.

Use of human acellular dermal matrix in rhinoplasty: a systematic review of the literature and meta-analysis.

Alloplastic implants such as acellular dermal matrix (ADM) have been used for various aesthetic and reconstructive purposes since the 1990s. Rhinoplasty addresses both aesthetic and functional nasal impairments, often involving the adoption of grafting materials. Currently, autologous grafts, such as those using septal cartilage, are the gold standard. However, they pose the risk of donor site morbidity, technical challenges, and additional operative time. We review total complications, resorption/re-operation and success rates associated with the use of ADM in rhinoplasty. A literature search was conducted on PubMed, Prospero, DynaMed, DARE, EMBASE and COCHRANE databases. (Registry: CRD42023428019). A total of 462 patients from 15 studies were included, the mean (range) age was 30 (12-65) years, with a female-to-male ratio of 2:1. The most common indications for ADM were for cosmetic (35%, n = 163) and functional rhinoplasty (5%, n = 24). The most common type of ADM used was Alloderm (46%, n = 211). The most common indication for ADM was dorsal nasal augmentation (68%, n = 314). Eleven patients (2%) required revision surgery. The pooled success of ADM in rhinoplasty was 96% (95% CI 94 to 99, p = 0.93; I2 = 0%). 2% of patients developed postoperative complications and no statistically significant difference was seen in complications or success rates when comparing the different types of ADM. ADM in rhinoplasty was associated with fewer complications and re-operation rates, and similar if not less resorption compared to traditional autografts. Therefore, it can be a viable alternative to current autologous grafts in rhinoplasty surgery.