title: Litigation associated with intensive care unit treatment in England: an analysis of NHSLA data 1995-2012.
abstract: BACKGROUND
  The intensive care unit (ICU) is a high-cost high-risk area in which analysis of previous litigation cases may help to improve future practice.
  
  
  METHODS
  Claims received by the National Health Service Litigation Authority (NHSLA) relating to ICU, from 1995 to 2012, were analysed according to clinical categories. The severity of outcome was classified as none, low, moderate, severe and death. The cost of the claims were corrected to 2013 values using the retail prices index.
  
  
  RESULTS
  Of the 523 claims in the NHSLA dataset, 210 were excluded (as the claims did not relate to ICU care) and 313 were included in the analysis. The commonest claim categories were [number (% of all claims)]: positioning/nursing standards/skin care (mostly relating to pressure sores)- 86 (28%), infection- 79 (26%), respiratory/airway- 63 (20%). The commonest claims relating to patient death were: respiratory/airway (30%), missed/delayed diagnosis (20%) and paediatrics (17%). The claims categories with the highest proportion of severe outcomes were: positioning/nursing standards/skin care (52%) and infection (33%). The total cost of closed claims was £19,973,339. The categories incurring the highest costs were: infection (£6.6 million), positioning/skin care/nursing standards (£4.5 million), delayed/inadequate treatment (£4.3 million).
  
  
  CONCLUSIONS
  Litigation arising from care in the ICU is common, costly, and is likely to follow a poor outcome. Whilst the importance of airway/respiratory care and infection control measures are highlighted, the clear prominence of pressure sores in ICU-related litigation is worrisome and represents one particular area for practice improvement.
authors.affiliation: University of Bristol Medical School,UK, Royal United Hospital NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK.
authors.forename: E
authors.initials: E
authors.lastname: Pascall
authors.affiliation: University of Bristol Medical School,UK, Royal United Hospital NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK.
authors.forename: S-J
authors.initials: SJ
authors.lastname: Trehane
authors.affiliation: Intensive Care Unit, Royal United Hospital NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK andypgeorgiou@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Intensive Care Unit, Royal United Hospital NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK.
authors.forename: T M
authors.initials: TM
authors.lastname: Cook
mesh_terms: D002648:Child; D004739:England; D006801:Humans; D007362:Intensive Care Units / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D008318:Malpractice / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*
keywords: airway management; claims; medicolegal; pressure ulcer