Complaints, Errors & Clinical Governance

“Working in the Emergency Department often affords junior doctors a level of autonomy and independent practice they have not experienced before. As a result of this junior staff may find themselves having to break bad news, deal with dissatisfied patients or relatives and being involved in critical incidents perhaps for the first time.”

EM Curriculum: (click to view)

Background

The Emergency Department is a unique environment to work in as a medical practitioner. The nature of the work we do, the unselected cohort of patients we see and the time and space pressures we work with all provide significant challenges and as a result the non-clinical skills of the healthcare workers are particularly important in the ED to ensure excellent patient care and patient safety are maximised.

Working in the Emergency Department often affords junior doctors a level of autonomy and independent practice they have not experienced before. As a result of this junior staff may find themselves having to break bad news, deal with dissatisfied patients or relatives and being involved in critical incidents perhaps for the first time.

The follow on from any mistake or incident should be clinical governance, which is a process by which looking at why thing went wrong should feedback no how to prevent it happening again. Understanding this and being involved in the process will allow you to implement positive changes in your department.

Learning Outcomes from completing the task

  • Recognise factors likely to lead to complaints.

  • Recognise that mistakes happen and it is important to be open about this.

  • Understand the consequences of medical error for those involved including the medical team.

  • Define Clinical Governance.

  • Recall the "Never Events" with reference to those that can occur in the ED.

Learning Outcome from face-to-face teaching

  • Outline the local complaints procedure.

  • Deliver an appropriate apology.

  • Distinguish between system and individual errors.

Tasks

Complete the following before the face-to-face session:

Task 1: Complaints

Duration: 10 mins

This short article taken from an MPS casebook provides some basic info about how complaints are on the increase, why this is so and how they can be avoided.

Task 2: Doctors Make Mistakes

Duration: 20 mins

This excellent Ted talk addresses the culture around mistakes and how we should discuss them openly and learn from them... after all we all make them.

Task 3: the Second Victim

Duration: 6 mins

This short video by Prof. Simon Carley at #RCEM15 (Manchester) briefly discusses medical error and the second victim syndrome which is an important concept to be aware both personally and as part of team so that you can support colleagues.

Prof. Simon Carley discusses ways to cope after making a medical error, with crucial take home points for anyone who works in an ED. Filmed at RCEM's Autumn Scientific Conference in Manchester 2015. For more information see Simon's blog at http://stemlynsblog.org/

TASK 4: Clinical Governance

Duration: 6 mins 

Whilst this video was made for foundation doctors, it serves to define clinical governance and covers some of the processes contribute to it. It is therefore a good place for doctors of all grades to start.

This video explores the often confusing term -Clinical Governance More videos available at www.f1toone.com

Task 5: Never Events

Duration: 15 mins

This document written by RCEM covers all the recognised "never events" and highlights those that are at risk of occurring in the ED.

 
 

CASE DISCUSSION

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

“Mrs Jones is a 40 year old patient who presented with a laceration to her right thigh sustained as she jumped off a removal van whilst moving house.”

ADDITIONAL RESOURCES

Here are some extra resources to review if you want more information:

CRITICAL INCIDENT REPORTING IN THE EMERGENCY DEPARTMENT:

This article is available via Athens, despite being in an anaesthetic journal it looks at emergency medicine. The reality is that errors and critical incidents occur everyday and at some point we will all be involved. There needs to be a culture shift to accept this and look at how to move forward and prevent further incidents, this is perhaps something that anaesthetists do better than we do. 

The article itself covers the types of error, how some errors compound each other and how this leads to the "swiss cheese model".

NHS COmPlaints Procedure:

This quick guide from the BMA details the different complaints procedures within the UK. With some links for further reading and some advice for doctors who have received a complaint.

COURSE FEEDBACK

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: