Risk management in the care of medical emergencies after referral to hospital.

An analysis of 40 medico-legal claims arising from the care of patients admitted as medical emergencies showed an excess of young patients (median age 45 years) but equal numbers of men and women. Twenty-nine patients died; with optimal management, 20 of these patients would have had a good chance of long-term survival. Of the 11 who survived, 3 were left with serious neurological deficits and 3 underwent intestinal resections that could have been avoided. Further analysis revealed probable defects in the organisation of care including: inadequate input from experienced clinicians; insufficient use of specialists; incorrect interpretation of radiographs and laboratory tests; and inadequate assessment of patients before discharge from hospital. It is suggested that there is an urgent need to collect and analyse data regarding adverse events in hospital medical practice in order to develop optimal organisational structures for the care of patients presenting as emergencies.