Emerald

The purpose of this paper is to discuss the analysis of complaints lodged by patients and how the complainants' letters are handled by health boards and clinicians.

A retrospective analysis of patients' complaints lodged with an independent voluntary citizens' association in Milan and, at the same time, against the hospital administration offices or the consultants and responses returned by the hospitals in reply to the patients. The authors assessed: the reasons for the complaints according to the citizen; the nature of the complaint according to a medical expert revue; and the handling of the complaint process by managers.

For 83 of 151 people (55 per cent), the reason was compensation for injury or pain. According to the medical review, in 54 cases (35.7 per cent), the main themes emerging were mainly “perceived” poor quality of care. Together, or alone, were problems of “technical” quality of care. A total of 94 complaints (62.2 per cent) had been dealt with by the Health Boards, but 48 cases (31.7 per cent) were dealt with by the legal office or the insurance company who replied without showing evidence that they had discussed events with clinicians. Many times the managers did not undertake a systematic investigation, leaving complainants dissatisfied with the process and the outcome.

This paper is the first to report the results of an assessment process of complaints lodged via an independent citizens' association in Italy.

Laparoscopic cholecystectomy is one of the most commonly performed general surgical operations and is associated with several potentially serious post‐operative complications. Informed consent is vital to avoid patient misunderstanding of risk and subsequent costly litigation. Consent practice at the authors' hospital was audited with the aim of investigating the quality of consent and assessing the impact of the introduction of a detailed patient information leaflet.

In total, the consent forms of 200 patients were examined; 100 patient consent forms were selected before and 100 after the introduction of a pre‐operative patient information leaflet, and retrospectively analysed.

Consultant staff obtained only 27 per cent of consent; 64 per cent of consent was taken on the morning of surgery. The most common risks mentioned were bleeding, infection, thrombo‐embolic risks and conversion to open. Other complications were mentioned inconsistently, with only 2 per cent of patients having documented evidence of receiving the information leaflet.

The authors demonstrate that consent for laparoscopic cholecystectomy remains inconsistent. The introduction of an information leaflet did not improve the documentation of risk required for informed consent.

The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology within the Northwestern Deanery of England.

An anonymous questionnaire was circulated among the Specialist Registrar trainees within the specialty attending a regional teaching session. The questionnaire was analysed.

There were 50 responses, of those 45 (90 per cent) had been involved in an adverse clinical incident; 44 had submitted an incident form related to the incident. Three had submitted incident forms without being involved in an adverse incident. Most (80 per cent) had submitted an incident form as well as a related statement. Feedback was available to 23 (51 per cent) of those involved in adverse incidents. More of the senior trainees received feedback than the junior ones. A lecture on clinical incident reporting was available to only 35(70 per cent) of the respondents on the hospital induction day at their latest clinical placement.

This study is limited to adverse clinical incident reporting among the trainees in a single specialty within one deanery in UK; hence the small numbers.

This study demonstrates the presence of awareness regarding adverse incident reporting among the trainees in a high‐risk specialty. It also shows the suboptimal rate of feedback following adverse incident reporting, which does not encourage a learning environment. It is suggested that a lecture should be dedicated to incident reporting at the junior doctors' induction day programme in every hospital.

This paper highlights the lack of adequate feedback following adverse clinical incident reporting.

The current risk management system for community mental health patients in England is based around the Care Programme Approach (CPA). This system is not responsive to changes in risk for community patients. This paper aims to introduce a practical system to manage risk that has been developed for an Early Intervention Service in East London on the basis of need.

Coding of red, amber and green is associated with specific criteria agreed by all disciplines in the team. The change of a code leads to a rapid change in risk level and management. An agreed clinical and non‐clinical action plan leads to a whole team response. The limitation of use is dependent on the size of the case load and the number of clinical staff attending a daily clinical briefing.

Zoning according to the traffic lights system could complement the CPA system and support a clinical governance structure utilising a whole team response.

The risk management system described has not been tested empirically. Currently it has been used in early intervention mental health teams but will need to be adapted for other teams with bigger case loads.

This practical risk management system is aligned with the statuary CPA requirements. A dynamic and flexible management of risk is central to early intervention in psychosis teams but the risk management system described can suit any community mental health team and fits well with the distributed responsibility model of functionalised teams according to new ways of working.

NCEPOD states that all emergency patients must have prompt access to theatres, critical care facilities, and appropriately trained staff 24 hours/day, every day of the year. The purpose of this paper is to determine waiting time for plastic surgery trauma patients and the financial implications to the NHS.

The approach was a prospective audit of emergency surgery (Lister Hospital, Stevenage) from July 2005‐January 2006. Delay times were calculated from booking time to time of operation. These were assessed on a standard of a day surgery unit, where the ideal maximum is a half day wait. Financial implications were calculated. The number of UK units without a dedicated list is highlighted.

A total of 615 operations were booked, 60 per cent of which were assessed as suitable for a DSU set up. With an ideal standard of half a day's wait, an average 22 per cent of patients achieved this, with 64 per cent of patients waiting one excess day. On average patients waited an excess of 1.3 days. An average of 24 excess bed days/week (bed cost £300/day) were used waiting for surgery. This equates to 1,400 bed days (£400,000/annum).

The paper shows how it is possible that 1,000 bed days/annum (£300,000) could be saved by a DSU type setup. With 61 plastic surgery units in the UK, 40 per cent reported no dedicated trauma list (93 per cent response rate). This is a potential saving of £8,400,000 per annum. From this audit a half day dedicated DSU list was created, and a re‐auditing process will occur.

This paper aims to examine the impact of a number of audits on clinical practice within a large mental health NHS trust. It aims to consider all audits that had been reaudited by psychiatry trainees and to compare the adherence to various standards before and after reaudit.

The authors examined all available clinical audits undertaken by psychiatry trainees that had been reaudited within Mersey Care NHS Trust. The results were analysed using SPSS version 16.0 for Windows. Differences between the results before and after reaudit were tested for using Pearson chi‐squared and Fisher's exact tests, both two‐tailed.

Significant improvements were noted in five of the 35 standards compared before and after reaudit. Only one reaudit, that of the assessment of physical health and of metabolic and cardiovascular risk in inpatients in Ashworth Hospital, showed significant deteriorations in adherence to the standards which was seen in seven of the nine parameters.

The reaudits demonstrated only a limited improvement in practice. This highlights the need for a more structured approach to involvement of junior doctors in clinical audit and more robust methods of dissemination and implementation of recommendations.