Minimise Risks in ENT Surgery

ENT surgeons undertake a wide range of interventions, and as with any surgery, there are potential risks to the patient and clinicians.

PMP has compiled the following risk tips to assist our ENT policyholders to identify and potentially mitigate surgical risks, thereby reducing the likelihood of complaints and/or claims. Our goal is to support you to enhance patient safety outcomes in every area of your practice.

Risk management tips

1. Training and performance improvement

• Consultants should engage in performance improvement opportunities and peer review activities to enhance technical surgical skills, ensure competency and improve performance and quality.
• In order to standardise processes, improve efficiency, and support quality of care, clinicians should follow evidence-based guidelines and clinical pathways.

2. Informed consent

• In accordance with the GMC’s Decision making and consent, clinicians should ensure they have a meaningful discussion with the patient prior to the procedure to enable the patient to make an informed choice. This should include details of the surgical procedure, risks, benefits and alternatives. In addition, consider what is most important to the individual patient, taking into account their lifestyle, employment and other individual circumstances.
• Provide information leaflets and consider directing the patient to useful websites: taking into account the patient’s literacy and language preferences and/or needs. Record in the medical notes any literature given or websites to which you refer a patient.
• Try to make sure that the information shared with patients about the options for treatment is objective.
• Document in detail the content of your discussion in the patient’s medical record.
• On the day of admission, recheck the patient understands the intervention and allow time for any further questions. Document this discussion in the patient’s record.
• Provide the patient with a consent form to sign, detailing the procedure and the associated risks and benefits.
• Keep a copy of the consent form in the patient’s medical records and provide the patient with a copy.

3. Communication

• Communicate adequate, clear, and appropriate information to patients, using layman’s terms when talking about procedures, anticipated benefits, potential risks, and alternative treatment.
• Offer interpreters and auxiliary aids to assist with patient communication and comprehension for patients who have limited English proficiency or disabilities related to their ability to communicate.
• Use a comprehension technique — such as teach-back — to gauge patient understanding and reduce the potential risk of miscommunication.
• Provide patients and families/caregivers with appropriate education and instructions prior to discharge. Document these details in the patients’ medical records.

4. Funding

• If the patient is self-funding, provide them with clear information about all the costs involved, including those associated with post-operative follow-up.
• Ensure the patient is aware of their right to a refund or return of deposit if they change their mind about the proposed treatment.

5. Surgery

• Review patient selection criteria for each procedure, and conduct a thorough pre-operative screening of patients for risk factors (including obstructive sleep apnoea).
• Ensure strategies are in place to minimise team communication breakdowns and encourage team members to speak up about safety concerns.
• Participate in surgical team timeouts prior to commencement of surgical procedures and complete the WHO Surgical Safety Checklist.
• Follow the recommendations in the NICE guideline on the prevention and treatment of surgical site infections.
• Carry out consistent post-procedure assessment processes.

6. Handover

• Allow adequate time for handover, prioritising tasks and plans for care and review of unstable patients.
• Ensure any post-operative deterioration and/or complications are communicated to all relevant staff, investigated and managed in a timely and appropriate manner.
• Record details in the patient’s medical records.

7. Duty of candour

• If the patient experiences an adverse outcome, it is important to investigate, explain and apologise to the patient. For further guidance on your ethical obligations, please refer to GMC guidance, Openness and honesty when things go wrong: The professional duty of candour. If you receive a complaint from a patient, or a patient suffers an adverse event, please call the medicolegal helpline as soon as possible. The helpline is open 24/7, every day of the year and can assist customers in preparing an appropriate response.

8. Learning from events

• An adverse event should be used as an opportunity to reflect, learn and adapt changes to a clinician’s practice and ultimately to improve care.

9. Record keeping

• Maintain clear and accurate medical records.
• Document a complete, concise, and accurate operative report the same day of each procedure. Ensure the entry is dated, timed and signed.
• These contemporaneous records will form the basis of any medicolegal defence, should this be necessary.

10. Professional indemnity insurance

• Ensure adequate professional indemnity insurance is in place to cover all interventions undertaken. Please remember that, in accordance with the terms and conditions of your insurance policy, you must advise PMP of any changes to the scope of your practice. Your insurance cover may be impacted if you do not inform us of such changes.