P046 Litigation within rheumatology: a retrospective analysis of claims data from England for the Getting It Right First Time programme

Background/Aims The 2021 Rheumatology Getting It Right First Time (GIRFT) report identified reducing the impact of litigation as a key objective underpinning its recommendations. We used NHS litigation data to explore the burden and trends in litigation within rheumatology over a five-year period. Methods Data regarding the number and quantum of claims were extracted from NHS Resolution from 2018/19-2022/23 where rheumatology was the recorded speciality. Comparisons were made with 2013/14-2017/18 data, published in the 2021 Rheumatology GIRFT report. Free-text claim data were analysed, to categorise reasons for litigation and identify learning insights. Results From 2018/19-2022/23, there were 169 litigation cases within rheumatology, across 79 providers. The most common injuries were unnecessary pain (n = 49), fatality (n = 11), joint damage (n = 9) and fracture (n = 9). Thirty-one claims (18%) related to inflammatory arthritis, with 24 (14%) relating to rare autoimmune rheumatic diseases (RAIRD), such as connective tissue diseases, vasculitis and haemophagocytic lymphohistiocytosis. Only four cases were explicitly related to giant cell arteritis. Of the 11 fatalities, where the relevant rheumatological diagnosis was specified, these were all RAIRD. Twelve claims involved complications of soft tissue steroid injection and six involved visual impairment resulting from hydroxychloroquine use. Sixty-one cases related to diagnosis (e.g. delayed or misdiagnosis), 48 to treatment (e.g. delayed or incorrect treatment), 28 to failures of monitoring or inadequate assessment, and 18 to failures to act on abnormal results, communicate with primary care, or refer to other specialities in a timely manner. The total cost of claims was £30.5 million, with six individual claims exceeding £1 million. The three highest related to delayed diagnosis of infective discitis resulting in paralysis (£2.7 million), failure to pre-screen for latent tuberculosis infection before initiating a biologic (£2.5 million), and failure to recognise crescendo transient ischaemic attacks prior to stroke (£1.8 million). Compared to the preceding five years (2013/14-2017/18) there was a reduction in number (169 vs 184) and quantum of claims (£30.5 million vs £46.1 million). Additionally, diagnostic issues have overtaken treatment issues as the leading source of claims. Only three claims related to consent, a reduction from 12 in the preceding five years. Conclusion There has been a modest reduction in the number and quantum of litigation claims in rheumatology. Whilst the total quantum was 33% lower in 2018/19-2022/23 compared to the preceding five years, there were still six individual claims exceeding £1 million, highlighting the ongoing importance of learning from litigation and taking steps to continually reduce the harm which may precede such claims. Fatalities relating to RAIRD highlight the need for clinician awareness, peer support networks, and timely diagnostics and treatment across rheumatology. The increasing proportion of claims related to diagnostic issues revealed the potential for improvement related to timely and careful clinical assessment.