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The scope of the problem

What is the scope of the problem in the NHS?

One in 20 hospital admissions results in avoidable patient harm [1]. So-called ‘never-events’ such as wrong site surgery and retained surgical instruments may happen as often as 1:100,000 and 1:10,000 respectively [2].

Threat of litigation is highly present in UK practice. Surgical mistakes contribute to the significant burden of NHS clinical negligence claims, with spending on pay-outs and settlements increasing rapidly in recent years, resulting in a bill of around £2.4 billion in 2018-19 [6]. Surgical specialties are documented to have the greatest number of litigious claims, with 2,847 over a ten-year period to 2019, though obstetrics and gynaecology has the highest total value of pay-outs [3].

Over 90% of surgeons report experiencing an intraoperative adverse event, most commonly within the last year. Whilst this can harm patients, the effect on the surgeon themselves can be significant and often overlooked. Amongst those surveyed they almost unanimously expressed strong feelings of anxiety, guilt, sadness, anger, shame, and/or embarrassment but few sought professional psychological counselling [4].

This article originally appeared in The Journal of Trauma and Orthopaedics A full version of this is available for free here


[1] Panagioti M, Khan K, Keers RN, Abuzour A, Phipps D, Kontopantelis E, et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: Systematic review and meta-analysis. The BMJ. 2019;366.

[2] Hempel S, Maggard-Gibbons M, Nguyen DK, Dawes AJ, Miake-Lye I, Beroes JM, et al. Wrong-site surgery, retained surgical items, and surgical fires a systematic review of surgical never events. JAMA Surg. 2015 Aug 1;150(8):796–805.

[3] Lane J, Bhome R, Somani B. National trends and cost of litigation in UK National Health Service (NHS): a specialty-specific analysis from the past decade. Vol. 66, Scottish Medical Journal. SAGE Publications Ltd; 2021. p. 168–74.

[4] Bohnen JD, Lillemoe KD, Mort EA, Kaafarani HMA. When Things Go Wrong: The Surgeon as Second Victim. Vol. 269, Annals of Surgery. Lippincott Williams and Wilkins; 2019. p. 808–9.


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