Since the beginning of 1990, health authorities have been responsible for monitoring claims of medical negligence arising within the NHS hospital service. By far the largest number of claims, over 80% in 1989, are solely attributable to hospital doctors,86 largely because these clinicians are more likely than community professionals to be involved in specialities such as surgery and anaesthetics and other complex invasive procedures that frequently involve intravenous cannulation. NHS Trusts are now actively seeking risk management advice and services, and will need to comply with requirements of the civil justice reforms implemented in April 1999.87 The introduction to the NHS of Clinical Governance has made Chief Executives explicitly accountable for quality of clinical care and standards of practice in their organisations.

In the USA, chemotherapy extravasations comprise a highly litigious area of oncology practice.88 In the UK, 2% of Medical Defence Union (MDU) cases involving anaesthetic-related injuries between 1970-1982 (excluding deaths) were due to extravasation.89 Between 1982-1986, the MDU dealt with three or four claims a year arising from extravasation injuries in premature infants, some of which resulted in permanent scarring.90

Litigation is increasing in the UK and medical negligence currently costs the NHS £300 million a year 91 compared with £23 million settled by the MDU for 759 claims in 1989.86 Taking all incidents into consideration, about 1% of in-patients experience negligent accidents to the point of claim but it is estimated that the overall rate of injuries or adverse outcomes possibly attributable to negligent medical management is considerably higher.87

Proactive risk management is being strongly promoted by the NHS Litigation Authority which also administers the Clinical Negligence Scheme for NHS Trusts. Clinical risk management involves identification, analysis and control of risks by initiating and documenting explicit and standardised care processes and monitoring variances against defined parameters.87 The control of risk is a crucial part of the quality package and it is essential that systems are in place at every level to ensure good practice and continuous improvements in clinical care.