Despite an alarming shortage of radiologists in the United Kingdom, claims for medical negligence in radiology are on the rise. New research in Clinical Radiology reviewed legal claims recorded by the National Health Service Litigation Authority (NHSLA) in the United Kingdom offered a snapshot of common and recurring trends to reduce the possibility of such incidents in the future.
“Errors are inevitable in all facets of medicine, but unlike some of our clinical colleagues, radiological discrepancies are cataloged and archived for all to see for years to come,” wrote author Oliver Hulson, MD, clinical radiologist at St. James University Hospital in Leeds, U.K.
Hulson reviewed litigation data provided by the NHSLA for settled claims against radiology between 1995 and 2014. Looking at 791 settled claims where radiology was implicated as the primary specialty at fault, Hulson found that missed or delayed diagnosis of a tumor accounted for 29 percent of the claims.
The cost of missed or delayed diagnosis claims was more than £15 million ($19.6 million). The average claim amount was £80,000 ($104,637). The largest claim was for £1.69 million ($2.2 million) due to a delayed diagnosis of a benign brain tumor that led to patient blindness.
Chest radiography, Hulson noted, accounted for 26 percent of the missed or delayed diagnosis claims. Additionally, 8 percent of claims were related to interventional radiology. Hulson noted the number of claims was too small to draw any perceived trends. Settled claims for interventional radiology totaled £4.3 million ($5.6 million); the average claim amount was £63,000 ($82,396); and the largest claim was for £379,000 ($495,687) due to a patient experiencing a stroke following angioplasty.
Claims related to interventional radiology included “alleged substandard technique,” bleeding complications post-procedure, consent issues, guidewire left in situ, wrong site surgery and “inappropriate” procedures.
Almost 10 percent of claims were settled due to an injury while they were in the radiology department—with a third of these cases due to a fall. These claims were of small value but still totaled £1.5 million ($1.7 million). The average claim amount was £16,544 ($21,624), while the largest claim was for £93,172 ($121,806).
Hulson noted fatigue and environmental factors may play significant roles in such mistakes. Previous literature, Hulson noted, has placed emphasis on “decision fatigue” increasing throughout the day due to repetitive, continuous and complex decision-making.
“It is vital that the current workforce is protected and allowed to work productively yet safely and effectively,” Hulson said. “Much is written in the literature regarding the effects of central nervous system or decision fatigue on reporting accuracy and error rates amongst radiologists.”
Additionally, Hulson noted systems and processes should be amended within radiology departments to ensure the most critical studies are reviewed first. Unexpected or significant findings should be “highlighted and escalated” quickly and appropriately.
“Claims for medical negligence are on the rise across the country, and continue to do so at an alarming rate,” Hulson wrote. “With the current pressures on radiology departments, coupled with a greater radiology frontline presence, with radiology-led clinics, issues surrounding duty of candor and radiology-instigated follow-up, one wonders whether the worst is yet to come. Unfortunately, there is no simple solution, but there are ways to mitigate and reduce our liability and attempt to close some of the holes in the ubiquitous ‘Swiss cheese.’”