Litigation related to anaesthesia: analysis of claims against the NHS in England 2008-2018 and comparison against previous claim patterns.

We reviewed all 1230 claims against anaesthesia notified to NHS Resolution (formerly the NHS Litigation Authority, 1995-2017) in England between 2008 and 2018. Claims were categorised by incident type, severity (whether physical or psychological), and cost, and comparisons were made against a similar published analysis of data from 1995 to 2007. While the annual number of claims against anaesthesia increased by 62% from the earlier period, anaesthesia now accounts for smaller proportions of all claims submitted to NHS Resolution (1.5% vs. 2.5%) and of the total cost of all claims (0.7% vs. 2.4%). The absolute costs related to anaesthesia claims rose over 300%, totalling £145 million between 2008 and 2018, but the mean cost per closed claim (retail price index adjusted) fell by 6% to £74,883. The most common clinical categories were regional anaesthesia (24%), inadequate anaesthesia (20%) and drug administration (20%). Claims related to airway management, central venous catheterisation and cardiac arrest remained infrequent but severe and costly. The proportion of claims relating to regional anaesthesia and obstetric anaesthesia fell significantly, but claims relating to peripheral nerve blockade doubled. Our analysis includes categories relating to organisational and human factors which are present in a substantial proportion of claims; categories with the highest mean cost per claim included delayed care, planning, monitoring and consent. Overall, the specialty of anaesthesia is at low risk of litigation. Our analysis provides important insights into current and changing patterns in claim distributions that may help improve the quality of patient care and reduce future litigation. We recommend the establishment of a structure for national review and learning from all cases of litigation.

Proximal humeral fractures with a severe varus deformity treated by fixation with a locking plate.

We treated 47 patients with a mean age of 57 years (22 to 88) who had a proximal humeral fracture in which there was a severe varus deformity, using a standard operative protocol of anatomical reduction, fixation with a locking plate and supplementation by structural allografts in unstable fractures. The functional and radiological outcomes were reviewed. At two years after operation the median Constant score was 86 points and the median Disabilities of the Arm, Shoulder and Hand score 17 points. Seven of the patients underwent further surgery, two for failure of fixation, three for dysfunction of the rotator cuff, and two for shoulder stiffness. The two cases of failure of fixation were attributable to violation of the operative protocol. In the 46 patients who retained their humeral head, all the fractures healed within the first year, with no sign of collapse or narrowing of the joint space. Longer follow-up will be required to confirm whether these initially satisfactory results are maintained.

Knowledge about genital herpes amongst first time attenders at a department of genitourinary medicine.

BACKGROUND AND AIMS: Genital herpes is the most common cause of genital ulceration in the developed world, and its prevalence in the United Kingdom is rising. Public knowledge of the infection is often limited. We aimed to assess knowledge among patients attending an outpatient genitourinary clinic in Scotland. METHODS: A questionnaire was designed to collect information about educational qualifications and knowledge of genital herpes. In the knowledge section, each correct answer was given a score of 1; thus the maximum possible score was 12. Two hundred and ten individuals who attended as new patients at a walk-in genitourinary medicine clinic were invited to complete the questionnaire. RESULTS: Two hundred and seven patients completed the questionnaire. Overall 63% of responses were answered correctly. Knowledge of genital herpes was better in patients who worked in healthcare (8.3 v 6.9, p=0.019) and in patients with educational qualifications gained from college or university compared to those gained at school (7.6 v 6.5, p=0.009). Level of knowledge was not related to age or gender; receiving sex education at school did not appear to improve knowledge of genital herpes. CONCLUSION: Knowledge of genital herpes among patients attending an outpatient genitourinary clinic in Scotland is reasonable but needs to improve to combat the rising prevalence of the infection. The areas of misunderstanding identified in our study could be targeted for public education.