An audit of litigation costs in four accident and emergency departments.

OBJECTIVE: To carry out an audit of cases of litigation relating to accident and emergency departments to determine the outcome and costs to the hospitals involved.
METHODS: The experience of four similar hospitals was examined over a three year period. All cases which required at least an exchange of solicitors' letters were included.
RESULTS: In total 32 claims were made, of which 17 were settled by solicitors' letters, six cases proceeded to court and were lost by the hospital involved, and in nine cases an out-of-court settlement was reached. The costs to the hospitals ranged from 180 pounds to 30,000 pounds, with an average cost of 4080 pounds. Over the course of the audit the number of cases of litigation remained constant at three per year, while the number of complaints rose threefold to 150. The majority of successful claims concerned missed fractures.
CONCLUSIONS: Litigation is uncommon and litigation costs reasonable. Given the frequency of missed fractures as a reason for a successful claim, early x ray reporting probably reduces the risk of litigation.