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The article examines the issues surrounding White Paper's uncovering of the proposal to reforming the health professionals' Trust, Assurance and Safety regulation in Great Britain. The White Paper expressed that to reform, the importance of perceptions must be rightly emphasized as public needs to perceive that the regulatory system is operating in the interests of patients. It also stresses that the General Medical Council's (GMC) four functions must be integrated in the regulatory framework.

This paper discusses how we have improved patient handover by implementing an electronic system for weekend handover. We discuss the process of changing handover methods and the results of an audit comparing our old paper based book versus our new 'e-handover' system. [ABSTRACT FROM AUTHOR]

Despite the term 'never events' these events continue to happen in the NHS. This paper considers the findings from a review of the causes of nine surgical 'never events'; looking at the learning from the investigations to provide 'a window on the system' and considering the multiple issues that need to be addressed to reduce future risk. The paper discusses why many of the causes described in investigation reports cannot be adequately addressed by the action plans that target each individual cause - things are never that simple - instead the causes should be seen as a reflection of the current state of safety within an organization, showing the underlying cultural and systems issues that need to be addressed at a wider level than that of the incident itself. [ABSTRACT FROM AUTHOR]

In the National Health Service in England there are many sources of information pertaining to patient safety. This paper sets out to describe the challenge of measuring patient safety and describes the key data sources that underpin the national understanding of the area. The paper will describe how utilizing all of the available patient safety data, irrespective of the variability inherent, can ensure that practising clinicians have a better understanding of the current picture of patient safety and can fully evidence the efficacy of their improvement actions. Examples of effective triangulation of these data sources are given with acknowledgement of the challenges this can present in terms of engagement and understanding, particularly in the clinical context. Recommendations for the effective use of information in the assessment of patient safety are also provided. [ABSTRACT FROM AUTHOR]

Abstract: The English National Health Service (NHS) announced a new programme to incentivize use of the NHS Safety Thermometer (NHS ST) in the NHS Operating Framework for 2012/13. For the first time, the NHS is using the Commissioning for Quality and Innovation (CQUIN) scheme, a contract lever, to incentivize ALL providers of NHS care to measure four common complications (harms) using the NHS ST in a proactive way on one day per month. This national CQUIN scheme provides financial reward for the collection of baseline data with a view to incentivizing the achievement of improvement goals in later years. In this paper, we describe the rationale for this large-scale data collection, the purpose of the instrument and its potential contribution to our current understanding of patient safety. It is not a comprehensive description of the method or preliminary data. This will be published separately. The focus of the NHS ST on pressure ulcers, falls, catheters and urine infection and venous thromboembolism is broadly applicable to patients across all healthcare settings, but is specifically pertinent to older people who, experiencing more healthcare intervention, are at risk of not one but multiple harms. In this paper, we also describe an innovative patient-level composite measure of the absence of harm from the four identified, termed as "harmfreecare" which is unique to the NHS ST and is under development to raise standards for patient safety. [ABSTRACT FROM AUTHOR]

The article discusses the issuance of various reports and consultation papers with regard to health care and medico-legal issues in Great Britain. The papers include proposals for the establishment of a Council of Health Regulators and the Kennedy Report on the Bristol Inquiry which deal with several pediatric care problems and proposed solutions.

In the United Kingdom, individuals requiring inpatient care for mental health purposes can be admitted to hospital with their consent as informal patients, or formally through procedure(s) prescribed by law. There are, however, instances where individuals otherwise referred to as informal patients are on admission without their consent or in circumstances that amount to deprivation of their liberty as defined by the United Kingdom Supreme Court and without recourse to lawful procedures by their clinical team as stipulated by the European Convention on Human Rights. Such instances might be without the awareness of the individuals or their clinical teams or the clinical teams might be unclear as to which statute applies to patient care. This paper has been written to help clinicians define the legal status of patients at the point of admission, during their stay on the inpatient unit and the statute(s) that apply to different in-patient situations. [ABSTRACT FROM AUTHOR]

Pressure ulcer prevention is core to nursing practice and as such is often overlooked as a safety risk. A multifaceted quality improvement initiative guided by both Felgen’s Model and the Model for Improvement delivered implemented in a systematic way led to significant improvements in the prevalence and incidence of pressure ulcers. Prevalence of all ulcers was reduced from 21% to 7% and to 3.1% when grade 1 ulcers are removed from analysis. Incidence (i.e. ulcers acquired in hospital) was reduced from 6.6% to 2.4% and 1.4% when grade 1 ulcers are removed from the analysis. Furthermore, improvements have been sustained for more than 2 years. This paper presents a case study of framework for change developed across a healthcare region NHS Tayside in Scotland. [ABSTRACT FROM PUBLISHER]

In the wake of the Mid Staffordshire Public Inquiry, this paper considers the arguments for and against the imposition of a statutory duty of candour on individuals, examining the validity of claims that such a duty would result in greater secrecy among healthcare professionals and lead to defensive practice. Examination of arguments for imposing an individual duty, highlights the pre-existing moral obligation on healthcare professionals to inform patients who have suffered harm, has not yet been sufficiently embedded throughout the NHS by professional codes of conduct, and the need to establish systematic formalised error reporting in order to continue to minimise clinical error. [ABSTRACT FROM AUTHOR]

The disclosure of adverse events to patients or their families who have been affected is considered to be a central feature of high quality and safer patient care, but despite this, as few as 30% of harmful errors may currently be disclosed to patients. Advocates of open disclosure propose that failing to communicate effectively with patients following adverse events may have negative repercussions for all stakeholders. The disclosure of adverse events and errors to patients and their families is partly fulfilling the duty of candour advocated in the numerous recent reports into the quality and safety within the NHS. This paper considers why disclosure remains challenging for organisations and professionals alike, despite guidance and in a clear moral imperative and commitment from stakeholders to transparency in healthcare. [ABSTRACT FROM AUTHOR]

This paper considers the judgments in JD v MELANIE MATHER [2012] EWHC 3063 (QB) and LORETTA OLIVER v GARY WILLIAMS [2013] EWHC 600 (QB) and how new prognostic models for breast cancer survival can be used by litigants to overcome the perceived injustices created by common law principles of causation established in Gregg v Scott [2005] UKHL 2. We consider how the use of epidemiological data in breast cancer cases permits the lawyer to pose the question of how a delay in diagnosis reduces life expectancy and how, in an increasingly high number of cases, that is preferable to the traditional approach of addressing only survival. By applying new statistical data to establish the effect of delay upon life expectancy, the court will be able to avoid apparent injustice without straining yet further established principles of common law causation. More importantly, in many cases for which redress is currently not available, it will better reflect the duty of the treating doctor and the expectations of the patient, something the common law should strive to achieve. This approach was applied in JD v MELANIE MATHER [2012] EWHC 3063 (QB) and considered in LORETTA OLIVER v GARY WILLIAMS [2013] EWHC 600 (QB). [ABSTRACT FROM PUBLISHER]

The aim of the paper is to assess open disclosure in Ireland following clinical adverse events in healthcare. A number of areas were examined from the patient's and healthcare team's perspectives. The barriers/constraints to open disclosure, the extent of policies, procedures or guidelines that are available for staff to consult with, inclusive of how they are implemented, harvested valuable insight. The supports available for healthcare staff following an adverse event and patients' expectations after such an event are also encompassed to include the relationship open disclosure has on concerns regarding litigious intent. The questionnaire was disseminated to a multidisciplinary healthcare group. The questions were numbered 1-9, with a mixture of open and closed questions. A five-point Likert format was used with three questions in attitudinal/ opinion statements, regarding supports available for staff following an adverse event. A Statistical Package for Social Sciences was used to assist with the interpretation of data. This study was directed at the multidisciplinary healthcare team and senior management within the Health Service Executive (HSE) and Voluntary sectors. The oldest hospitals in Ireland are voluntary public hospitals some of them originating from the 18th century, having been established by charities and religious orders. Voluntary hospitals are partly funded by the HSE, specifically having their own governance structure. There was a response rate of 67% (n ¼ 192). A total 56.5% of respondents stated their organization did not have an open disclosure policy, procedure or guideline in place however, 16% of the attendees stated there was one in place. A total of 54.4% (104) acknowledged barriers/concerns surrounding open disclosure, with fear of litigious intent noted by 24% of respondents. A total of 52.3% (101) identified support availability to staff following an adverse event, 38.9% (10) felt there was little/no follow-up support, with 11.1.% (2) stating they were made to feel guilty, and associated it with being "on trial". Findings demonstrate an unstructured approach to disclosure of adverse events in Ireland, with fear of litigation a major concern for healthcare professionals. Error awareness among the general public, the introduction of protective legislation and implementation of a national standard on open disclosure in conjunction with practical training and education will all positively and practically influence open disclosure of adverse events in Ireland. [ABSTRACT FROM AUTHOR]

Healthcare is a highly regulated environment. This has driven what could be characterized as a papersafe approach, whereby organizations are required to demonstrate to a multiplicity of regulators, inspectorates and accrediting bodies that they are paper safe. However, for many organizations, this has not produced a system which is actually patient safe; rather it has in practice operated as a parallel system that does not reflect the true state of safety. This project looks at a quality improvement and patient safety programme and critically asks the question of whether it is flawed because of failure to address issues surrounding Doctors and cultural change. We used Johnson & Schole's cultural web framework to explore the attitudes of junior doctors towards a patient safety and quality improvement programme. Data collection was through the use of focus groups backed up with quantitative data from a web based questionnaire survey. It has been demonstrated that Doctors represent a dominant sub-culture within the NHS and their beliefs, attitudes and value are often at odds or unrecognized by senior healthcare managers. Unless the cultural differences are adequately addressed then transformational change projects such as 'Best and Safest Care' are unlikely to succeed. A better understanding of the organizational context allows for more appropriate change interventions to be developed. [ABSTRACT FROM AUTHOR]

In July 2010, the Government published the White Paper Equity and Excellence: Liberating the NHS, which places a strong emphasis on patient safety, sets the long-term vision for the NHS and describes a coherent framework of reform to deliver health care amongst the best in the world. Good nutritional care is a prerequisite of safe care and hence fundamental to the achievement of this vision, especially for vulnerable individuals. This article outlines the prevalence and costs associated with malnutrition and the impact of malnutrition on patient safety within the context of the current NHS reforms. It concludes with guidance for clinicians and senior managers which, where fully implemented, will facilitate good nutritional care and ensure compliance to nutritional guidelines, standards and legislation including the regulations relating to nutrition as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 and the Care Quality Commission (Registration) Regulations 2009. [ABSTRACT FROM AUTHOR]

This paper highlights the issue of independent midwives practising without professional indemnity insurance. The paper explains the history of the provision, decline and now absence of insurance for midwives who practise independently. Despite the government's commitment to professional indemnity insurance cover for all health professionals working independently and not covered by the Clinical Negligence Scheme for Trusts, an exception has been made for independent midwives. The paper questions how the government can maintain its commitment to choices for maternity care yet permit midwives to care for pregnant women and attend at the birth of a baby without requiring insurance. There is no mandatory requirement to insure by the Nurses and Midwives Council (NMC). Without a mandatory requirement to insure the only advice given to midwives by the NMC is that they should inform their patients of the insurance position. The way in which information should be given is not stated and the practice is not consistent. Little information on the implications of lack of insurance is provided to parents considering retaining an independent midwife for the birth of their child. This situation leaves parents and children exposed to a situation where there is a clinical negligence claim no possibility of obtaining damages from an uninsured Defendant of limited personal means. [ABSTRACT FROM AUTHOR]

Failure to use or interpret laboratory tests correctly is a relatively uncommon cause of direct patient harm in National Patient Safety Agency (NPSA) listings although can have disastrous results in some patients. Evidence-based laboratory medicine does not follow the same criteria as many clinical interventional situations because of the absence and unfeasibility of randomized controlled trials in many situations. Much good practice is therefore based on level 4 evidence or consensus expert opinion. Much of this opinion is scattered throughout the medical literature and not readily available to medical practitioners. This paper describes the development of a web-based resource to provide rapid access to 'heuristics' to guide appropriate use and interpretation of laboratory tests, using the specific example of drug safety monitoring. [ABSTRACT FROM AUTHOR]

The article offers information on the implication of public inquiries to the medical profession in Great Britain. It focuses on the scheme of understanding a statutory inquiry following a major incident raising public concern. It also looks into key subjects in relevance to doctors' involvement in inquiries and their rights and obligations. Public inquiries are cited to be inquisitorial approach of the public in relation to the provision of public medical services, doctors and health systems.

Introduction There is an increasing expectation for the NHS to deliver a constantly up-to-date health service that is both safe and patient-oriented. This paper outlines the findings of a new risk assessment tool implemented across the organization targeted specifically to medical devices. Method The process employs a new medical devices risk assessment tool (MeDRa) to collect quantitative data relating to the contributory factors and control measures associated with medical devices used in the clinical setting. The tool utilises the responses from healthcare professionals as the 'real experts' in assessing risk to compute risk ratings for each device. Consequently the risk assessments are validated through the professional judgement of the clinical staff. Results As the data is inputted, the software tool computes the individual risk profiles for device categories in the particular clinical setting. A macro perspective of medical device risk is produced through statistical analysis and mathematical modelling using cross-tabulations. Risk perceptions are influenced by the differences in professional roles of nursing and medical staff. The outcome of the analysis is a report on medical device risks across the organization and an associated action plan, which identifies ways of mitigating those risks. Conclusions This approach efficiently produced risk assessments for each clinical area across the whole Trust in a matter of weeks. The MeDRa tool collated evidence to satisfy many of the criteria necessary for the external assurance framework. The subsequent statistical analysis and mathematical modelling highlighted a number of issues across the Trust that required interventions. [ABSTRACT FROM AUTHOR]

Using data from the UK National Reporting and Learning System and the National Health Service Litigation Authority, this paper assesses trends in patient safety incidents and litigation in relation to ophthalmic surgery generally and vitreoretinal (VR) surgery in particular. Examples of human error and equipment-related incidents in VR surgery are discussed. Data from incident reporting and litigation should be interpreted with care as these are influenced by many factors. An open culture, improved reporting and prioritisation of patient safety will help provide further insight into the prevalence and causes of patient safety incidents in VR surgery. [ABSTRACT FROM AUTHOR]

The 'Modern Matron' is one of the prominent nursing roles to emerge from the NHS Plan. The underpinning principle is to have a professional leader who is accountable for co-ordinating safe, high-quality care to improve patients' NHS experience. This paper discusses findings from a study of the implementation of the Modern Matron role in an acute NHS Trust in the East of England. The theoretical framework of 'limiting harm' was used to assess the extent to which the Modern Matron could contribute towards safe effective care and the reduction of harm. The study found that error-prone situations were clearly identified and that the Matrons were perceived to have a positive impact on a range of clinical issues. The evidence from this small study suggests that the Modern Matron role has the potential to make a positive contribution to patient safety. [ABSTRACT FROM AUTHOR]

In the current environment of culture change and financial pressure on the National Health Service, quality improvement initiatives are heralded as new vehicles for workplace evolution. Foundation Year One doctors encounter many of the problems impinging on quality, and their enthusiasm and number make them an indispensable resource and critical mass for improvement. In response to the increasing importance of quality improvement training, and as part of an ongoing project to embed quality improvement education in the Severn Deanery region, this paper describes the evolution of a questionnaire tool to assess the attitudes and beliefs of a cohort of new Foundation Year One doctors. An electronic survey was developed and validated to address each aim of quality care. The survey was sent by email to every Foundation Year One doctor in the Severn Deanery. New Foundation Year One doctors' attitudes are overwhelmingly positive towards quality improvement and patient safety; however, universally, they do not feel valued and listened to. In addition, they do not feel that their previous medical education has fully equipped them to improve the quality and safety of the care they deliver to their patients. Foundation Year One doctors represent a large, intelligent and enthusiastic workforce and in an environment where quality is now accepted as paramount, harnessing their potential through better quality improvement training could prove advantageous to all National Health Service stakeholders. [ABSTRACT FROM AUTHOR]

This paper summarises the problem of the recognition and management of sepsis in in-patients. A case vignette describes a common scenario faced by trainees, in which timely and effective care is difficult to deliver. We offer suggestions for possible changes in hospital systems and care delivery that are likely to lead to better outcomes. [ABSTRACT FROM AUTHOR]

The criminal law looks set to play a larger role in regulating healthcare. Until recently, health professionals only faced the prospect of criminal liability if it could be proved that their gross negligence resulted in the death of a patient. In such a case, the professional could face a charge of gross negligence manslaughter (GNM). Prosecutions for ‘medical manslaughter’ have generated concern among doctors worried about what is perceived as a rise in the number of doctors facing criminal prosecution and the impact prosecutions are having on healthcare practice. May more frequent resort to the criminal process damage rather than promote better health care? In seeking to try to answer this question, the first problem is that reliable data in this area about how many prosecutions are brought and how they fare are limited due to the way cases are recorded. What evidence does exist is often based on media reports or samples that are not representative. This paper will argue that, while the real risk of being prosecuted for medical manslaughter remains low, such fears should not be dismissed because, as Donald Berwick has argued, ‘fear is toxic’ – for health professionals and their patients. [ABSTRACT FROM AUTHOR]

The author reflects on the condition of the health professional regulation in Great Britain. He notes the Coalition Government's move in promoting its Health and Social Care Bill. He also mentions the failure of the Channel 4 "Dispatches" programme in October 2011. Moreover, the author cites the need for health professionals to guard against political ideology and expediency that eliminate one's hardwork and learning.

This article explores what role lawyers can play in contributing to learning from those incidents that result in a litigation claim. Specifically the authors consider what role the NHSLA has played and should be playing in improving patient safety. [ABSTRACT FROM AUTHOR]

The author reflects on the response of the Lord Chancellor to the consultation paper "Damages of Future Loss: Giving the Courts the Power to Award Periodical Payments in Personal Injury Cases" in Great Britain. He says that the consultation paper has led to the implementation of a provision made to the Courts Bill. The author argues that the Bill gives the Lord Chancellor the power to make regulations concerning variability or review of periodical payments.

The article presents an analysis of consecutive actions in alleged medical negligence relating to breast surgery in Great Britain. It is said that claims in medical negligence are likely to rise in relation to increased patient expectations. The analysis focused on female claimant patients who have undergone breast surgery. Reasons for the claims in relation to injuries suffered by patients are cited.

An introduction is presented in which the editor discusses articles in the issue related to patient safety regulation and technology in healthcare delivery, including Adam Darkin's article on practical implications of implementing telehealth services and Gordon Caldwell's paper on clinical leadership value.

The author reflects on the significance of launching the campaign of the organization Action against Medical Accidents (AvMA) for enacting the Robbie's Law in Great Britain. He points out that the campaign would deliver significant changes in the medical service culture. He comments on the replacement of the guidance implementation to the national health service which has caused offence to patients and their families. He also remarks that the changes do not detract for introducing the law.

The article presents news briefs concerning legal issues related to medical care in Great Britain. A White Paper will be released in early 2002 on options for reforming the processing of clinical negligence claims and reducing costs associated with such claims. The Council for the Regulation of Healthcare Professionals has been created to supervise the work of several regulatory bodies. Drug labeling proposals have been announced by the Committee on Safety of Medicines.

Government reforms and restructuring of the NHS are hitting the headlines. But its policy on voluntary registration over statutory regulation has been largely overlooked -- and in the case of clinical physiology is a tragedy waiting to happen, according to Anne Burge, Chair of the Registration Council for Clinical Physiologists. [ABSTRACT FROM AUTHOR]

The author talks about the controversy on obstetric brachial plexus injury (OBPI) in Great Britain. He discusses several reviews on the paper written by Anthony Noble regarding the causes of OBPI. Noble claimed that OBPI may be caused by forces of labor, not by excessive traction on the fetal neck. Questions on the role of forces in OBPI are presented.

The article comments on the impact of the clinical negligence Pre-action Protocol in Great Britain. The protocols, which were introduced in April 1999, are said to be one of the most innovative aspects of the Civil Procedure Rules. As of September 2000, the Lord Chancellor's Department had not commissioned research into the impact of the personal injury and clinical negligence protocols on the investigation and settlement of claims.

An introduction is presented in which the editor discusses various topics within the issue including risks to patients, perspectives of patients, practitioners and policy makers and learning points.

This article (written in April 2013) considers the observations and recommendations made in the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry as to a duty of candour and, in particular, the recommendation that there should be a statutory duty of candour imposed on healthcare providers, as well as on registered medical practitioners, nurses and other registered professionals, who believe or suspect that patient treatment or care has caused death or serious injury. The article details the Government's initial response to such recommendations, in which it indicated an intention to introduce a statutory duty for health and care providers, and sets out the contractual duty of candour that is currently included in the NHS Standard Contract for 2013/14 (SC35). There is then an analysis of the terms of the contractual duty contrasted with those of the proposed statutory duty; a look at the limitations of the contractual duty; a discussion of some of the issues that may arise in relation to when the relevant duty (either contractual or statutory) will be triggered; a consideration of the apparent novelty of a statutory duty of candour in English law; and a brief discussion in relation to the potential remedies, penalties and offences that may be adopted if such a statutory duty comes into force. In conclusion, on any basis the imposition of the contractual duty of candour and the intention to introduce some form of statutory duty heralds a new era in relation to candour in healthcare. [ABSTRACT FROM AUTHOR]

Medical authorities have historically either been silent or circumspect about the role of candour in clinical relationships. Hippocrates told doctors to abstain from doing harm, not entertaining the possibility that they might be negligent, while in 1847 the American Medical Association declared that doctors have: ‘a sacred duty … to avoid all things which have a tendency to discourage the patient and depress his spirits’. Being candid about an injurious mistake in the course of treatment would no doubt discourage even the worldliest of 19th century patients. However, in recent years, the focus has shifted: doctors in 21st century have an obligation to disclose even the most depressing of mistakes. This modern ‘duty of candour’ is found in a mish-mash of moral principles, regulatory guidelines and contractual agreements but following the Francis Report it will be buttressed by statute. [ABSTRACT FROM AUTHOR]

The article discusses the application of candour to reduce the distress in the workplace. Topics include the duty of candour in motivating doctors and other healthcare professionals, openness in writing and explaining medical diagnosis and decision making, and the need to change the daily routine of healthcare workers particularly in terms of patient management.

The article describes the use of Lovebug diagram, a combination of Fishbone diagrams and force-field analysis, in root cause analysis (RCA) in the healthcare settings. The limitations of fishborne diagrams and the strengths of Lovebug diagram compared to Fishbone diagrams and force-field analysis are discussed. The use of Fishbone diagrams in assessing planned and unplanned changes is noted.

The article presents several case studies related to maternity claims. It states that in one of the cases a sonographer wasn't able to identify fetal bladder and later the baby was born with bladder exstrophy. It mentions that in another case a woman claimed disabling fecal incontinence due to a third-degree tear during delivery. It highlights that in another case a woman claimed that she was not advised properly by a hospital about uterine rupture due to labor induction.

"Failure to rescue" is the inadequate or delayed response to clinical deterioration in hospitalized patients. Rapid response systems are a set of hospital-wide interventions that attempt to reduce failure to rescue by improving patient monitoring on general wards (the afferent component) and the reliability of the response to deterioration by a dedicated Critical Care Outreach Team, Rapid Response Team or Medical Emergency Team (the efferent component). The reliability of such systems depends on the faultless functioning of a "chain of survival" consisting of: (1) high-quality recording of vital signs; (2) the education and mind-set of staff at the bedside to recognize pathological patterns; (3) the reporting of abnormality to the efferent team; (4) a timely and appropriate response by the latter. Repeated feedback loops are crucial for an effective functioning of the chain. [ABSTRACT FROM AUTHOR]

Allegations of poorly performed circumcisions may arise as negligence claims, civil claims or a professional (General Medical Council [GMC]) matter. This article explains the various types of circumcision, including those done for religious purposes, and attempts to provide an understanding of the issues relating to claims. The writer is a medicolegal expert (Accident & Emergency Consultant) who trained in surgery and for over 25 years has performed neonatal circumcision for religious purposes (usually in the home), child circumcision and adult circumcision. He has provided reports for both claimant and defendants, in negligence claims, civil claims and GMC proceedings. [ABSTRACT FROM AUTHOR]

There is increasing evidence to support the safety and reliability of ultrasound-guided regional anaesthesia (regional nerve 'blocks' using local anaesthetic drugs) in the setting of elective orthopaedic surgery. In response to a patient safety incident that occurred while under general anaesthesia (GA), we set out to offer awake regional nerve blocks to high-risk patients as a safe alternative to GA. Between September 2010 and July 2011, 43 patients scheduled for elective upper limb surgery on 'high-risk lists' were given a regional anaesthetic for their operation. Patients were followed up by telephone interview 24 hours post-surgery to monitor complications and to gain patient feedback. We also assessed regional anaesthesia in terms of efficiency and patient satisfaction. Overall 42/43 patients were successfully blocked (1/43 converted to GA). 'Blocked' patients were able to bypass the 'post anaesthesia care unit', and could proceed straight to the ward after their operation in the majority of cases. Nobody was dissatisfied with their anaesthetic, and 40/41 would chose regional anaesthesia again over GA. Ultrasound-guided regional anaesthesia is a reliable alternative to GA and is associated with high patient acceptability. In the setting of a UK NHS district general hospital, availability of ultrasound-guided regional anaesthesia may help to improve patient safety, patient choice and postoperative efficiency. The findings of the service evaluation support our ongoing use of this technique. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses approaches to improve patient care such as continuing education and training for clinicians, competence-based training programmes, and inter-organizational learning.

The article focuses on the significance of the national screening programme for abdominal aortic aneurysm (AAA) in Great Britain outlined by vascular surgeon Hany Hafez. It cites the principles of the screening including the condition of health problems, the availability of facilities for diagnosis and effective treatment, and the use of acceptable test. It further stresses that the AAA screening will reveal a population of elderly men at risk of death from ruptured aneurysm.

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The article presents a case study of Dorothy, an elderly lady with dementia and questionable mental capacity to arrive at a better understanding of the challenges faced in the treatment of older people in hospital with impaired mental capacity. The key things to be kept in mind in the assessment of patient mental capacity are described. The best strategy to be followed should be defensible decision-making; with the focus on the process followed rather than the end decision itself.

Incapacitated patients must be treated in their best interests according to the Mental Capacity Act 2005. As a result of this statute, the General Medical Council has advised that the testing of incapacitated source patients for HIV following occupational needlestick injury is unlawful. In this article, the reasons for the introduction of the Act are outlined and the impact of the legislation on the profession discussed. It is argued that it is in the patient's medical best interests to know if they are HIV positive so that they can be treated appropriately whilst they are incapacitated on ICU and begin timely medical therapy. It is in their social, emotional, cultural and religious best interests to be tested so that they can alleviate the anxiety of the injured healthcare worker, change their behaviour to avoid further spread and contribute to wider society as a 'good egg'. It is concluded that the GMC has misunderstood the meaning of best interests and that their advice should be revised to allow testing to occur. [ABSTRACT FROM AUTHOR]

The inquest process has proved to be an important vehicle for the development of Article 2 European Convention Human Rights. The extent of the duties imposed on Member States to preserve each of their citizen's right to life is now clearer than it has ever been, although there is still a need for further clarification. The case law in this area continues to develop quickly. It is hoped that by sharing some of our case studies this will help lawyers and clinicians to keep abreast of the developments in the law. [ABSTRACT FROM AUTHOR]

The case of Ryan St George v Home Office [2008] EWCA Civ 1068 raised unusual issues on breach of duty, causation and contributory negligence. The 29 year old claimant had a history of alcohol and drug abuse, withdrawal seizures, and previous custodial sentences. Five days after his admission to Prison he sustained a substance withdrawal seizure injury, falling from the top bunk and striking his head on a concrete floor. He developed status epilepticus and subsequent irreversible brain damage. The medical case on causation was whether the head injury resulting from the fall triggered status epilepticus or whether the status epilepticus was a consequence of the withdrawal seizure alone. Mackay J held that the head injury triggered the status epilepticus and that the Home Office had acted in breach of duty following the claimant's admission to prison when he was allocated a top bunk in a dormitory wing. A novel issue on contributory negligence arose because Mackay J reduced the claimant's damages by 15% because his injuries were caused partly by his substance abuse, therefore his "fault" within the meaning of section 1(1) of the Law Reform (Contributory Negligence) Act 1945 ("the 1945 Act"). There had been no previous direct authority on this point. The judge's findings were the subject of an appeal to the Court of Appeal where in the leading judgment Dyson LJ dismissed the appeal against the findings on breach of duty and causation and allowed the crossappeal against the finding of contributory negligence. [ABSTRACT FROM AUTHOR]

Consultants have considerable freedom and power to improve the quality and safety of clinical care within their services. Whatever happens to healthcare in the future, patients acutely unwell with critical illnesses will be taken to hospital. The priority work of acute hospitals will always be to treat these patients with high-quality effective clinical care to swiftly and safely restore their health so that they can resume living outside hospital. For a small proportion of patients the work is to anticipate and provide for a calm end of life. Integral to this work is also the training of the next generation of healthcare professionals. Over the last five years I have been working to improve quality and safety at the point of care in acute general medicine. I discuss some of the successes and hope to open the reader's eyes to the potential for improvement in acute care processes, if clinicians and managers work together to optimize working at the point of care. [ABSTRACT FROM AUTHOR]