title: Litigation claims relating to venous thromboembolism in the NHS.
abstract: OBJECTIVE
  Litigation costs for clinical negligence in the management of venous thromboembolism have escalated in the last five years. The National Health Service Litigation Authority estimates these claims have cost in excess of £112 million. Our aim is to identify the areas of practice where these claims are most likely to arise to help improve patient outcome.
  
  
  METHODS
  The National Health Service Litigation Authority provided de-identified data on individual medical negligence claims against the NHS since 2007. We subcategorised the data into (a) the nature of the venous thromboembolism event, (b) the area of specialist practice and (c) the damages incurred. Inter-group differences were evaluated using ANOVA, Kruskal-Wallis test and Mann-Whitney U Test.
  
  
  RESULTS
  Failure to prevent and to diagnose pulmonary emboli and deep vein thrombosis occurs across the spectrum of clinical specialties. In the study period 189 claims were made. The majority of claims were in surgical specialties and the financial burden was significantly greater than in the medical specialities (£3,257,394 vs. £1,532,996). The amounts paid out by specialty was not significantly different but had significant variance (p < 0.0001).
  
  
  CONCLUSIONS
  The National Institute of Clinical Excellence provides comprehensive guidelines on venous thromboembolism risk assessment. Poor compliance has contributed to morbidity and mortality while the cost has continued to escalate. A multimodal approach to education is needed to improve patient outcome. Improved venous thromboembolism prevalence data are also needed.
authors.affiliation: Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: White
authors.affiliation: Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nath
authors.affiliation: Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK Gerard.Stansby@nuth.nhs.uk.
authors.forename: Gerard
authors.initials: G
authors.lastname: Stansby
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007603:Jurisprudence; D008297:Male; D008318:Malpractice / Q000191:economics* / Q000331:legislation & jurisprudence; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D020246:Venous Thrombosis / Q000175:diagnosis / Q000191:economics* / Q000628:therapy
keywords: Complications; VTE prophylaxis; hospital-acquired venous thromboembolic disease; pulmonary embolism; venous thromboembolism