Avoiding Errors in Paediatrics

Joseph E. Raine is Consultant Paediatrician, Whittington Hospital, LondonKate Williams is Partner, RadcliffesLeBrasseur Solicitors, LeedsJonathan Bonser is Consultant in the Healthcare Department of Fishburns LLP, Solicitors, London, and former Head of the Claims and Legal Services, Department of the Leeds office of the Medical Protection Society

• Contributors, viiiForeword, ixAbbreviations, xiIntroduction, xiiiPart 1Section 1: Errors and their causesA few words about error, 1Learning from system failures – the vincristine case, 1Person-centred paediatric errors and their causes, 8The patient consultation, 10Failure to identify a sick child, 12Inability to perform practical procedures competently, 13Failure to check test results or act on abnormal findings, 15Prescribing errors, 16Failures in resuscitation, 17Sources of error in child protection cases, 19References and further reading, 22Section 2: Medico-legal aspectsError in a legal context, 25Negligence, 25Medical negligence, 26Issues around consent, 29Confidentiality, 34References and further reading, 37Part 2 Clinical casesIntroduction, 39Case 1 A boy with a limp, 40Case 2 A fitting infant, 43Case 3 A persistent fever, 45Case 4 A biking injury, 48Case 5 A teenager with abdominal pain, 51Case 6 A young girl with a vaginal discharge, 54Case 7 An iatrogenic problem, 57Case 8 An infant with a large head, 59Case 9 An infant with bloody diarrhoea, 62Case 10 An infant with persistent jaundice, 64Case 11 A child with leukaemia and tummy ache, 66Case 12 A boy with fever and rigors, 68Case 13 A stiff hand, 70Case 14 A serious feeding problem, 72Case 15 Fits, faints and funny turns, 74Case 16 A hospital acquired infection, 76Case 17 Recurrent wheeze, 79Case 18 A jaundiced neonate, 82Case 19 A febrile boy with a limp, 85Case 20 A febrile neonate, 87Case 21 A neonate with abnormal movements, 89Case 22 A teenager with scrotal pain, 91Case 23 A boy with nonspecific symptoms, 93Case 24 A delayed walker, 96Case 25 A diabetic girl with a headache, 98Case 26 A boy with sickle cell disease and a fever, 101Case 27 Negative test results, 104Case 28 A bad case of ‘flu, 107Case 29 A difficult transfer, 110Case 30 Treatment for tonsillitis, 112Case 31 Increasing respiratory distress, 114Case 32 A feverish girl with poor feeding, 116Case 33 An infant with a swollen face, 118Case 34 Starting a new treatment, 121Case 35 The importance of interpretation, 124Case 36 A febrile boy with a scald, 126Part 3 Investigating and dealing with errors1 Introduction, 1292 How hospitals try to prevent errors and their recurrence, 1293 The role of hospital staff, 1344 External investigators, 1365 Hospital investigations, 1386 Legal advice – where to get it and how to pay, 1437 External inquiries, 1468 The role of the doctor, 1659 Emotional repercussions, 16710 Conclusion, 169References and further reading, 169Index, 171

“My experience as an expert witness in clinical negligence cases, MPTS Panel chairman, medical adviser to a Public Inquiry and as a sometimes commissioned independent reporter on adverse incidents tells me that these are excellent books, valuable for all clinicians, not just those in high-risk specialties; and all NHS managers involved in maintaining or improving the quality of care. The case vignettes, alone, are useful source material for teaching medical trainees on what can go wrong and how to deal with it when it does.” (Harvey Marcovitch, Clinical Risk journal) "This book is well written and easily read. It is divided into three main parts. The first part deals in general terms with the areas in which errors tend to occur. The importance of good communication, both written and oral, is repeatedly stressed. The contribution of poor management and of system errors in the creation of problems is not overlooked. The section on legal aspects of errors, including discussion of negligence, consent and confidentiality is concise and clear.The second part consists of thirty-six case studies. These are interesting and thought provoking, with questions for the reader at significant points in the progress of each case. An expert opinion, legal comment and key learning points are given at the conclusion of each case.Part 3 gives information and advice on responding to complaints, managing mishaps and navigating the hazards of police, court and GMC involvement. Again it is concise and helpful.After sections 1 and 3, and after every case study in section 2, references and suggestions for further reading are given.I would strongly recommend this book to all paediatricians, at all levels. It is well structured, easy to read and informative. I would also like to see medical and non-medical managers reading it, as it puts into perspective the role of system failures that so often contribute significantly to clinical errors. I think that general practitioners would also find it well worth reading." (Hilary Haines,  F.R.C.P.C.H., F.F.P.H.)Pre-publication reviews:“I think in Medicine it is always best to learn from others’ mistakes rather than waiting until you make your own. In addition, knowing what you can expect if a complaint is made goes some way to emphasising the importance of avoiding errors in the first place. Should a complaint be made, forewarned is forearmed.” (ST1 in Paediatrics)“The format of presenting “real life” cases with expert clinical and legal commentary is both entertaining and highly informative.” (Consultant Paediatrician)