ACC Treatment Injury Profile: South Canterbury DHB

ACC Treatment Injury Profile: South Canterbury DHB Prepared: January 2011 Contents Introduction... 1 Treatment Injury Claim Lodgement... 1 National Profile: Treatment Injury... 2 District Health Boards: Treatment Injury... 4 DHB Claim Lodgement Comparison: Jan Dec 2009... 7 South Canterbury DHB: Treatment Injury... 9 National Profile: Adverse Event Notifications... 10 All DHBs: Adverse Event Notifications... 13 South Canterbury DHB: Adverse Event Notifications... 14 Appendix... 15 How ACC can help... 16 Introduction The Treatment Injury Centre has two key roles: assessing treatment injury claims for cover, and notifying events which may constitute a risk of harm to the public to the Director General of Health. The Treatment Injury legislation is outlined in the appendix. This profile gives an overview of treatment injury claims and adverse event notifications. The data reviewed is generally regarding the 2010 calendar year, except where otherwise noted. If there is further information that would be of interest, the Treatment Injury Centre is able to respond to requests. The ACC website contains further information on treatment injury, along with all previously published treatment injury case studies (http://www.acc.co.nz/forproviders/clinical-best-practice/case-studies/index.htm). These are published on a monthly basis with the ACC news to share information and support quality of care. Treatment Injury Claim Lodgement From 1 July 2005 to 31 December 2010 the ACC Treatment Injury Centre has received 39,883 claims, of which 38,596 have been decided. Of the decided claims, 3,493 claims were either withdrawn, declined due to a lack of information, or referred for consideration under the broader personal injury criteria. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n

Of the remaining 34,375 decided treatment injury claims, 22,618 claims (66%) were accepted and 11,757 (34%) were declined. The most common reasons for declining a claim were that no physical injury could be identified (46%), there was no causal link between treatment and the injury (27%), the injury was an ordinary consequence of treatment (12%) and that the injury was wholly or substantially caused by the underlying health condition (10%). Treatment injury claim lodgement has grown rapidly over the first four years of the scheme, however much of this growth has been in high-volume, low-cost injuries, such as allergic reactions. 47% of all claims are lodged from GP practices, 31% by staff working within DHBs, 15% by practitioners at private hospitals or clinics and 7% were other types of practice or could not be identified. Treatment Injury Claim Lodgement: Jul 2005 Dec 2010 Claims Lodged per Month 900 800 700 600 500 400 300 200 100 0 Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Month of Lodgement Accept Decline Decline - Other Undecided NB: Decline other represents claims which were withdrawn, declined due to a lack of information, or referred for consideration under the broader personal injury criteria. Also, as this data is to the end of December 2010, only half of the 2010-2011 fiscal year is represented. Claims shown as undecided were awaiting a decision at 31 December 2010. National Profile: Treatment Injury National Top 10 Accepted Treatment Injuries 2010 The most commonly accepted treatment injuries nationally lodged during 2010 are outlined in the graph below. Although the top 10 treatment injuries are generally high volume, low cost claims, taken together they may entail high cost. In addition, Oct-10 A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 2

Treatment Injury ACC Treatment Injury Claims and Adverse Event Notification Profile each injury category will contain a small number of more high-cost, serious injury claims. Wound Infection Allergic reaction Haematoma - Bruising Nerve Damage Cellulitis Anaphylactic reaction Ulcer - Pressure area/decubitus Skin damage/injury/tear Tooth - chipped/damaged Deep vein thrombosis 0 50 100 150 200 250 300 350 400 450 500 550 Count of Accepted Claims Not identified Private Public NB: The Private category denotes all care given outside the DHBs including primary care/general practice, community dental and physiotherapy care etc. National Top 10 Accepted Treatment Injuries: Relationship to Event for 2010 Wound infection is most commonly associated with the general surgery context, with 32% of all accepted wound infection claims arising from orthopaedic treatment. The most common event categories resulting in wound infection are removal of skin lesion (125 accepted claims) and knee surgery/replacement (57 accepted claims). Allergic and anaphylactic reaction claims have been most commonly accepted in relation to commonly prescribed antibiotics, such as augmentin. The large discrepancy between claims for allergic reactions being lodged in the private, versus the public sector is due to significant numbers of low-cost claims for minor antibiotic reactions being lodged by primary care clinicians. Allergic reaction claims have increased from 417 to 436 for the last two years and anaphylactic reactions claims have also increased from 83 to 114 for the same period. Haematoma and bruising claims are most often lodged in relation to venous puncture (33 accepted claims decreasing from 38 the previous year) and IV cannulation (24 accepted claims increasing from 18 the year prior). There are smaller proportions of claims relating to major surgical haematomas. Nerve damage most commonly relates to IV cannulation (17 accepted claims last year decreasing from 20 claims the previous year), venous puncture (16 accepted claims in 2010 declining from 27 claims in 2009) and hip surgery/replacement (11 accepted claims increasing from 9 the year prior). Cellulitis is also commonly related to IV cannulation (40 accepted claims 2010 mirroring 2009), vaccination (14 accepted claims decreasing from 19 the previous A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 3

ACC Treatment Injury Claims and Adverse Event Notification Profile year), and knee replacement surgery (10 accepted claims decreasing from 12 in 2009). The injury categories skin damage/injury/tear and pressure areas are related to nursing care. Accepted claims for pressure ulcers normally relate to inadequate pressure area prevention or management, such as no risk assessment, no prevention plan or a lack of pressure area care. Tooth chipped/damaged relates most commonly to general anaesthetic, endotracheal intubation and intubation other (57 accepted claims last year, similar to the previous year) and also to tooth extraction and various dental treatments (18 accepted claims declining from 20 the previous year). Deep vein thrombosis is most commonly related to the orthopaedic context with 73% of claims arising from orthopaedic treatment. The most common event categories resulting in deep vein thrombosis are knee surgery or replacement (16 accepted claims increasing from 11 the previous year), plaster or fibreglass cast (13 accepted claims last year increasing from 10 the year prior) and immobilisation during ongoing care (8 accepted claims in 2010 increasing from none in 2009). Deep vein thrombosis claims have increased by 57% in the last two years (80 accepted claims last year increasing from 51 claims in 2009). Accepted claims have increased continually from 2006 when 15 were accepted. District Health Boards: Treatment Injury This section gives an overview of District Health Boards treatment injury claims and patterns of interest. Of the 7,552 decided treatment injury claims for 2010, 3,922 claims (52%) arose as a result of treatment events within DHB facilities. Of the 3,922 decided DHB claims, 2,576 claims (66%) were accepted and 1,346 (34%) were declined. Of the declined claims, the most common reason for declining was that no physical injury could be identified. The next most common reason was that no causal link could be evidenced between the injury and treatment from a health professional. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 4

All DHBs: Top 10 Accepted Treatment Injuries for 2010 Compared to Previous Year Treatment Injury Wound Infection Presure Ulcer/Skin Damage Haematoma - Bruising Allergic reaction Nerve Damage Cellulitis Deep vein thrombosis Tooth - chipped/damaged Perineal damage/injury/tear Perforation - Bowel 0 50 100 150 200 250 300 350 400 450 500 550 Count of Accepted Claims 2009 2010 All DHBs: Top 10 Accepted Treatment Injuries for 2010 Compared to Previous Year Wound infection is most commonly associated with the general surgical context, with 38% of all accepted wound infection claims arising from general surgery. The next most common is the orthopaedic context (33% of accepted claims). The most common event categories resulting in wound infection are removal of skin lesion (58 accepted claims increasing from 35 the year prior) and knee surgery/replacement (35 accepted claims mirroring the previous year). The injury categories skin damage/injury/tear and pressure areas are related to nursing care. Accepted claims for pressure ulcers normally relate to inadequate pressure area prevention or management, such as no risk assessment, no prevention plan or a lack of pressure area care. Pressure ulcers have increased from 92 accepted claims in 2009 to 105 accepted claims in 2010. Accepted claims for both these injury categories have increased from 120 to 159 over the past two years. Haematoma and bruising claims are most often lodged in relation to IV cannulation (14 accepted claims increasing from 11 the year prior), angiogram and angioplasty (8 accepted claims decreasing from 10 the previous year) and venous puncture (6 accepted claims almost mirroring 2009). There are smaller proportions of claims relating to major surgical haematomas. Allergic reaction claims have been most commonly accepted in relation to commonly prescribed antibiotics, such as augmentin. The large discrepancy between claims for allergic reactions being lodged in the private, versus the public sector is due to significant numbers of low-cost claims for minor antibiotic reactions being lodged by primary care clinicians. Accepted claim numbers are similar in the last two years. Nerve damage most commonly relates to hip surgery/replacement (10 accepted claims increasing from 6 the previous year) and IV cannulation (9 accepted claims A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 5

decreasing from 13 the year prior). Overall, nerve injury claims accepted annually have remained consistently in the mid forties since 2006. Cellulitis is also commonly related to IV cannulation (38 accepted claims last year, similar to the previous year) and knee surgery/replacement (7 accepted claims last year decreasing from 9 the year prior). Deep vein thrombosis is most commonly related to the orthopaedic context with 69% of all deep vein thrombosis claims arising from orthopaedic treatment. The most common event categories resulting in deep vein thrombosis are plaster or fibreglass cast (12 accepted claims last year increasing from 7 the year prior), knee surgery or replacement (8 accepted claims increasing from 5 the previous year), and immobilisation during ongoing care (7 accepted claims in 2010 increasing from none in 2009). Deep vein thrombosis claims have doubled in DHBs in the last two years (50 accepted claims last year increasing from 24 claims in 2009). Accepted claims have increased continually from 2006 when accepted claims numbered 3. Tooth chipped/damaged relates most commonly to general anaesthetic, endotracheal intubation and intubation other (42 accepted claims in 2010 mirroring 2009) and also to scoping procedures (5 accepted claims last year decreasing from 8 the previous year). Perineal damage, injury or tear relates wholly to the maternity context. The most common event categories resulting in perineal injuries were ventouse delivery (28 accepted claims in 2010, more than triple the 8 accepted claims in 2009) and forceps delivery (16 accepted claims last year, four times the 4 accepted claims the year prior). Overall accepted claims in this group have slowly increased from 18 in 2007 to 24 in 2009, and then more than doubled to 58 in 2010. Bowel perforations claims have decreased slightly over the last two years from 37 to 35 accepted claims. The event category most commonly related to bowel perforation is colonoscopy (54% of accepted claims). Various abdominal surgeries are related to 31% of accepted claims. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 6

DHB Claim Lodgement Comparison: Jan Dec 2009 The table below provides a high-level comparison of TI claims lodged for injuries related to care provided at DHB facilities in the 2009 calendar year. The figures represent all claims lodged regarding care given by that DHB within the period specified, regardless of whether the claim was lodged by DHB staff or externally. Variation in claim rates between DHBs may depend on multiple factors including demography, differences in service provision, and variable knowledge of the Treatment Injury scheme. TI claim lodgement rates are not a proxy for the incidence of injuries due to treatment in the sector, and claims lodged may only represent a proportion of treatment injuries occurring nationally. The rate of accepted TI claims is not representative of quality and safety of treatment amongst DHBs. Data Sources and Definitions Claim rate comparisons for each DHB are generated on the basis of publicly funded discharge figures for DHB facilities in the 2009 calendar year as this is the most recent comparable 12 month period. Discharge data was sourced from the National Minimum Dataset (NMDS) at 5 November 2010. TI claim data is based upon treatment injury claims lodged in the 2009 calendar year, as obtained at 13 November 2010. The lodgement of TI claims may not occur in proximity to the treatment event, thus some claims lodged in this period will relate to treatment events pre-dating 2009. Data exclusions include claims where treatment occurred at a facility outside NZ, where the DHB of treatment could not be determined, where the claim was attributed to a non-treatment Injury fund, and where publicly-funded procedures were performed at private facilities. National Treatment Injury Data: Jan Dec 2009 Between 1 January and 31 December 2009, ACC received 8,242 treatment injury claims, of which 3,959 (48%) were related to treatment events within DHB facilities 1. Of these, 133 were withdrawn, declined due to lack of information, or referred for consideration under the personal injury provisions. Of the remaining 3,826 claims, 2,508 (66%) were accepted. 1 This excludes 76 claims which were attributed to fund accounts other than treatment injury. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 7

Treatment Injury Claim Lodgement by Publicly Funded Discharges and DHB Region: Jan Dec 2009 DHB Lodged Lodgement 2009 Accepted Claims per TI Decided Accepted (% of 10,000 Discharges TI Decided) 2009 Capital and Coast 426 406 275 (68%) 46.0 Taranaki 139 135 99 (73%) 37.3 Waitemata 497 482 318 (66%) 36.2 Wairarapa 47 46 31 (67%) 35.4 Otago 169 164 104 (63%) 32.2 Bay of Plenty 194 187 149 (80%) 31.1 South Canterbury 74 71 42 (59%) 31.0 Hutt Valley 122 116 78 (67%) 27.8 Waikato 386 374 234 (63%) 26.1 Hawkes Bay 133 132 92 (70%) 25.2 Tairawhiti 46 46 30 (65%) 24.6 Whanganui 67 64 41 (64%) 24.2 Canterbury 389 379 240(63%) 23.1 Lakes 89 87 58 (67%) 22.8 Northland 170 164 114 (70%) 22.7 Nelson Marlborough 105 103 62 (60%) 22.6 Southland 69 66 45 (68%) 22.3 Auckland 459 438 270 (62%) 21.6 MidCentral 111 109 63 (58%) 17.6 West Coast 16 15 9 (60%) 14.5 Counties Manukau 215 208 136 (65%) 12.3 NB: TI claims data sourced 13 November 2010, and NMDS data sourced 5 November 2010 for publicly-funded discharges from DHB facilities. TI Decided excludes claims withdrawn, declined due to a lack of information, or referred for consideration under the broader personal injury criteria. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 8

South Canterbury DHB: Treatment Injury ACC Treatment Injury Claims and Adverse Event Notification Profile This section gives an overview of South Canterbury DHB treatment injury claims and patterns of interest. Of the 3,922 decided DHB treatment injury claims for 2010, 67 claims (2%) occurred within South Canterbury DHB. Of the 67 decided South Canterbury claims, 50 claims (75%) were accepted and 17 (25%) were declined. Of the declined claims, the most common reason for declining was that no physical injury could be identified and that no causal link could be evidenced between the injury and treatment from a health professional. South Canterbury Claim Lodgement: Jul 2005 Dec 2010 The graph below shows the number of claims lodged which arose from care given by South Canterbury DHB. This includes claims lodged by non-dhb staff, such as General Practitioners. 2010 2009 2008 Year 2007 2006 2005 0 20 40 60 80 100 Count of Accepted Claims Accept Decline Decline - Other Undecided NB: Decline other represents claims which were withdrawn, declined due to a lack of information or referred for consideration under the broader personal injury provisions. Claims shown as undecided were awaiting a decision at 31 December 2010. Of the 64 lodged South Canterbury claims in 2010, 66% were lodged by DHB staff, 25% by GPs, and 8% by clinicians in private hospitals and clinics. Nationally, 53% of claims lodged regarding care given by a DHB were lodged by DHB staff in 2010, so South Canterbury staff are lodging a comparatively greater proportion of claims related to treatment injuries occurring in their care than the national average. Of claims lodged regarding South Canterbury by DHB staff, the accept rate was 88%. This is higher than the average across all DHBs of 74%. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 9

The most common reasons that claims regarding South Canterbury DHB in 2010 were declined included that there was no causal link between the injury and treatment (29%), that no physical injury could be identified (50%), and that the injury was considered to be an ordinary consequence of treatment (14%). South Canterbury DHB Top Accepted Treatment Injuries for 2010 Compared to Previous Year In 2010, the most common injury types relating to care given by South Canterbury DHB were: Pressure Ulcers (7 accepted claims compared with 3 in 2009) Wound infection (7 accepted claims compared with 5 in 2009) Skin damage (6 accepted claims decreasing from 13 the previous year) Cellulitis (4 compared with 1 in 2009) Fracture leg/foot/pelvis (4 compared with 1 in 2009) Pressure ulcers as described in the national and DHB comparisons are related to nursing care. Accepted claim numbers have more than doubled in 2010 compared with any previous year. Total accepted claim numbers from 2005-2009 (8 claims) were similar to the number of accepted claims in 2010. Wound infection was most commonly associated with the orthopaedic context (43%). The most common event category was knee and hip surgery or replacement (3 accepted claims). Wound infection claims have increased slightly from 5 claims in 2009 but remain much reduced from the 21 and 14 accepted claims in 2008 and 2007. While the orthopaedic context dominated with 50-60% of the accepted claims prior to 2010, the general surgical context superseded that position for wound infections in 2008 with 52% of accepted claims. Skin damage claims have halved in the last year and the most common event categories are related to removal of drapes in theatre and handling of upper limbs (5 accepted claims). Fracture of leg, foot or pelvis claims have increased to 4 accepted claims, double the total claims in previous years. The orthopaedic context is wholly related to these fracture claims in 2010. There were no patterns of events related to the remaining top injury categories from 2010. The most common single events leading to injury at SCDHB in 2010 were hip surgery or replacement (8 accepted claims), nursing/immobilisation (6 accepted claims), knee surgery or replacement (4 accepted claims) and I.V. cannulation (3 accepted claims) with no other pattern to the types of injuries resulting. National Profile: Adverse Event Notifications Between 1 July 2005 and 31 December 2010, ACC made 1,808 notifications of belief of risk of harm to the public. This figure also includes any urgent notifications. The Director General of Health receives a copy of all notifications and in some cases notifications are also made to Registration Bodies. Only notifications to Registration Bodies include the name of the involved health professional. In order to make a notification to a Registration Body ACC requires A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 10

clear documentation of the health professional s involvement in the event and external peer advice that the care provided was inappropriate. 2 A sentinel event has been defined as: An event during care or treatment that has resulted in an unanticipated death or major permanent loss of function not related to the natural course of the client's illness or underlying condition, pregnancy or childbirth. A serious event has been defined as: An event, or related events, that have the potential to result in death or major permanent loss of function not related to the natural course of the client's illness or underlying condition, pregnancy or childbirth. National Top 10 Adverse Event Notifications by Treatment Event for 2010 The top 10 most commonly notified treatment events are outlined in the graph below. Treatment Event Delay/Failure to Treat Medication Administration Equipment Failure/Loss Medication Dispensing Nursing/Immobilisation CABG/Cardiac Valve Surgery Venous Catheterisation/Angioplasty Medication Prescribing Injection Hip Surgery/Replacement 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Count of Adverse Event Notifications Sentinel Serious NB: 65 notified events relate to the category medication other and have not been included in this profile. These represent adverse reactions to drugs prescribed and given correctly, and are generally notified for surveillance purposes to Medsafe. National Top 10 Adverse Event Notifications: Patterns and Relationship to Injury Notifications for delays and failures to treat in 2010 most commonly related to: 2 External Peer Advice may be from an ACC External Clinical Advisor, a Health and Disability Commissioner s advisor or a Coroner s advisor. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 11

Progression of disease (13 notifications, down from 16 in 2009), most commonly the diagnosis and management of cancer (92% of disease progression notifications). Recurring patterns have emerged around communication issues, such as follow up of test results and reports, the interface of primary and secondary care, and the quality of documentation. Infant hypoxic brain injury, cerebral palsy or stillbirth (14 notifications, up from 6 in 2009). Common themes included ensuring appropriate identification and referral for antenatal risk factors, monitoring and responding to intrapartum distress, and postnatal case of at-risk infants, particularly neonatal hypoglycaemia and jaundice. Cerebrovascular accidents/haemorrhage (8 notifications, up from 1 in 2009), particularly regarding red-flag symptoms and signs in patients presenting with headache. Medication administration adverse event notifications frequently relate to the five wrongs of medication administration (person, drug, dose, route, time). No injuries were associated with 70% of medication administration notifications in 2010. Equipment failure or loss related most commonly to separating parts, retained equipment and prosthetic failure. Some events were related to injuries to internal organs and structures. There were no patterns regarding the involved equipment. Nursing/Immobilisation adverse event notifications are most commonly related to pressure areas. Accepted claims for pressure ulcers normally relate to inadequate pressure area prevention or management, such as no risk assessment, no prevention plan or a lack of pressure area care. Medication dispensing relates to medications dispensed incorrectly by a pharmacist however no patterns related to the type of medication or cause of the error were identified in notifications made in 2010. Coronary artery bypass graft and cardiac valve surgery notifications were most commonly related to cerebrovascular accidents. Other cardiac complications such as tamponade and failure were notified. These notifications were generally made regarding injuries that were the result of care given appropriately, but which were sufficiently severe to require notification. Gastrointestinal scoping procedure adverse event notifications are related to gastrointestinal perforations, most commonly bowel perforation. Venous catheterisation and angioplasty notifications are most commonly related to arterial and venous dissection, perforation or damage. Less commonly, some injuries also involve damage to organs. Medication prescribing notifications generally relate to the concomitant prescription of medications which are cautioned or contraindicated, or to mistakes in drug selection or dosing. Hip surgery/replacement notifications in 2010 afforded no identified patterns to injuries. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 12

All DHBs: Adverse Event Notifications DHBs Top 10 Adverse Event Notifications by Treatment Event for 2010 The top 10 most commonly notified treatment events relating to DHB care in 2010 are outlined in the graph below. Treatment Event Delay/Failure to Treat Nursing/Immobilisation Medication Administration Equipment Failure/Loss Venous Catheterisation/Angioplasty Hip Surgery/Replacement Radiotherapy/Cobalt Scoping Procedures CABG/Cardiac Valve Surgery Cholecystectomy - Laparoscopic 0 5 10 15 20 25 30 35 40 45 50 55 Count of Adverse Event Notifications Sentinel Serious NB: 42 notified events relate to the category medication other and have not been included in this profile. Delays and failures to treat most commonly relate to birth asphyxia (9 notifications last year compared to less than 4 notifications in 2009), the diagnosis and management of cancer (8 notifications decreasing from 10 notifications the previous year), CVAs, cerebral or subarachnoid haemorrhage (8 notifications last year increasing from less than 4 notifications the year prior) and less commonly relate to brain damage or injury including non-birth hypoxia (4 notifications compared with 3 the previous year). Nursing/Immobilisation adverse event notifications are most commonly related to pressure areas (7 notifications in 2009 increasing to 10 notifications last year). Accepted claims for pressure ulcers normally relate to inadequate pressure area prevention or management, such as no risk assessment, no prevention plan or a lack of pressure area care. Medication administration adverse event notifications frequently relate to the five wrongs of medication administration (person, drug, dose, route, time). No injuries were associated with 30% of medication administration notifications in 2010. The treatment contexts of oncology and nursing were each related to 30% of the medication administration notifications. Equipment failure or loss related to equipment malfunction and separating parts during surgery. Injuries to internal organs and structures related to 3 notifications in 2010 and no notifications the year prior. Notifications for equipment failure or A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 13

loss have increased from 5 notifications for the whole period of 2006-2008 (no notification in 2005 and 2009) to 8 notifications in 2010. Venous catheterisation and angioplasty notifications are most commonly related to arterial and venous dissection, perforation or damage (3 notifications). Injuries less commonly extend to affect organs. Notifications have doubled over the last two years to 6. Coronary artery bypass graft and cardiac valve surgery notifications were most commonly related to cerebral haemorrhages (3 notifications last year, half the notifications for the previous year). Notifications reached a peak in 2009 with 14 notifications, decreasing to 5 last year. Gastrointestinal scoping adverse event notifications are related to gastrointestinal perforations, most commonly bowel perforation. Notifications have increased to 5 in 2010 with less than 4 in 2009. The number of radiation treatment notifications have mirrored the previous year (5 notifications). Treatment injuries included excessive doses and radiation induced disease. Hip surgery/replacement notifications in 2010 had no identified patterns of injuries (5 notifications last year increasing from less than 4 the year previous). Bile duct injuries resulting from laparoscopic cholecystectomy are notified where there is morbidity or mortality that reaches the threshold for notification, or where there are identifiable technical issues with the surgical technique. This is similarly the case for bowel perforations in relation to colonoscopy. Notifications in 2010 for bile duct damage or injury reduced to 3 from 4 notifications the year prior. Laparoscopic cholecystectomy notifications halved in the last two years from 6 to 3. South Canterbury DHB: Adverse Event Notifications In 2010 ACC made 3 notifications of risk of harm to the public relating to South Canterbury: 1 Sentinel 2 Serious There were no identified patterns to event or injury. Overall notifications remain under 4 for each year except 2007 when notifications reached a height of 6. If there is further information that would be of interest, the Treatment Injury Centre is able to respond to requests TI.Info@acc.co.nz A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 14

Appendix Legislation The Treatment Injury provisions covered in the Accident Compensation Act 2001, section 32, and can be summarised as follows: Treatment injury relates to an injury occurring when a person is seeking or receiving treatment from one or more registered health professionals. The injury cannot be a necessary (e.g. piercing of skin during vaccination) or ordinary (e.g. mild fever following vaccination) part of treatment. Also considered are the person s underlying health condition and the clinical knowledge at the time of treatment. There are also some exclusionary criteria which include outcomes where treatment does not achieve the desired result; where the person has unreasonably withheld or delayed consent to undergo treatment; injuries that are solely attributable to a resource allocation decision. A PDF copy of the full Injury legislation can be downloaded from http://www.legislation.govt.nz/act/public/2001/0049/latest/viewpdf.aspx?search=qs_ act_treatment+injury_resel&p=1 Claim Lodgement Treatment Providers can lodge Treatment Injury claims by filling out an ACC45 form, along with a 2152 Treatment Injury Claim Form. These forms are available on the ACC website, and should be freely available in most hospitals. Quality information provision, such as clear 2152 forms and timely provision of medical notes and records, assists ACC to reach a decision on cover quickly. The lodging provider may seek information about the status of a claim through the online e-lodgement portal. Considering the information in context It has been estimated that the treatment injury claims received by ACC represent approximately 10% of all possible eligible claims for adverse treatment events. Davis et al estimate that 12.9% of New Zealand hospital admissions are associated with an adverse event of which one-third are preventable 3. In 2002 Brown et al estimated the cost of preventable adverse events at $NZ 590 million or 30% of the annual public hospital expenditure 4. 3 Davis P., Lay_Yee R., Briant R., Ali W., Scott A & Schug S.(2003). Adverse events in New Zealand public hospitals II: preventability and clinical context. The New Zealand Medical Journal, 116 (118). 4 Brown P., McArthru C., Newby L., Lay-Yee R., Davis P & Briant R.(2002). Cost of medical injury in New Zealand: a prospective cohort study. Journal of Health Services Research, 7(Supplement 1 to issue 3), pp 29 34. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 15

How ACC can help ACC Treatment Injury Claims and Adverse Event Notification Profile Following acceptance of a claim for treatment injury, possible assistance may include: treatment costs weekly compensation for salary or wages lost because of the injury personal help, such as home help or childcare travel costs, such as to and from treatment equipment, such as crutches, wheelchairs and visual aids changes to the home, such as rails or wheelchair ramps. Entitlements are managed either through cost centres or, in the case of more serious injuries, through the local ACC branch office. About Elective Services An elective service is one or more personal health treatment procedures, provided or required in any of the following cases: A specialist undertakes an assessment seven days or more after a general practitioner (GP) makes written referral. A client is admitted to a healthcare facility seven days or more after the completion of an assessment that recommends they are admitted to the facility. A client who is admitted as above receives an outpatient service and community service associated with their admission. A client attends an outpatient clinic or community service seven days or more after the completion of an assessment that recommends they receive the outpatient or community service. A specialist obtains ACC s prior approval to admit a client to a healthcare facility for inpatient non-acute/elective surgical treatment (i.e. surgery that can wait at least 7 or more days), within seven days of the decision to admit Note: Elective services do include inpatient surgical treatment with a clinical priority of non-acute/elective, even if the admission is planned for within 7 days of the decision to admit. This is because the bulk payment ACC makes to the Crown for public health acute services does not include funding for non-acute/elective treatment. Prior approval should be sought even if a cover decision has not yet been made. Dylan Tapp Clinical Analyst, Treatment Injury Tel: 04 560 5268 Email: Dylan.Tapp@acc.co.nz Averill Frew Business Analyst, Treatment Injury Tel: 04 560 5263 Email: Averill.Frew@acc.co.nz A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 16