Avoiding Errors in Paediatrics
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Some of the most important and best lessons in a doctor’s career are learnt from mistakes. However, an awareness of the common causes of medical errors and developing positive behaviours can reduce the risk of mistakes and litigation.

Written for junior paediatric staff and consultants, and unlike any other paediatric clinical management title available, Avoiding Errors in Paediatrics identifies and explains the most common errors likely to occur in a paediatric setting - so that you won’t make them.
The first section in this brand new guide discusses the causes of errors in paediatrics. The second and largest section consists of case scenarios and includes expert and legal comment as well as clinical teaching points and strategies to help you engage in safer practice throughout your career. The final section discusses how to deal with complaints and the subsequent potential medico-legal consequences, helping to reduce your anxiety when dealing with the consequences of an error.

Invaluable during the Foundation Years, Specialty Training and for Consultants, Avoiding Errors in Paediatrics is the perfect guide to help tackle the professional and emotional challenges of life as a paediatrician.


Joseph E. Raine is Consultant Paediatrician, Whittington Hospital, London

Kate Williams is Partner, RadcliffesLeBrasseur Solicitors, Leeds

Jonathan Bonser is Consultant in the Healthcare Department of Fishburns LLP, Solicitors, London, and former Head of the Claims and Legal Services, Department of the Leeds office of the Medical Protection Society


Contributors, viii

Foreword, ix

Abbreviations, xi

Introduction, xiii

Part 1

Section 1: Errors and their causes

A few words about error, 1

Learning from system failures – the vincristine case, 1

Person-centred paediatric errors and their causes, 8

The patient consultation, 10

Failure to identify a sick child, 12

Inability to perform practical procedures competently, 13

Failure to check test results or act on abnormal findings, 15

Prescribing errors, 16

Failures in resuscitation, 17

Sources of error in child protection cases, 19

References and further reading, 22

Section 2: Medico-legal aspects

Error in a legal context, 25

Negligence, 25

Medical negligence, 26

Issues around consent, 29

Confidentiality, 34

References and further reading, 37

Part 2 Clinical cases

Introduction, 39

Case 1 A boy with a limp, 40

Case 2 A fitting infant, 43

Case 3 A persistent fever, 45

Case 4 A biking injury, 48

Case 5 A teenager with abdominal pain, 51

Case 6 A young girl with a vaginal discharge, 54

Case 7 An iatrogenic problem, 57

Case 8 An infant with a large head, 59

Case 9 An infant with bloody diarrhoea, 62

Case 10 An infant with persistent jaundice, 64

Case 11 A child with leukaemia and tummy ache, 66

Case 12 A boy with fever and rigors, 68

Case 13 A stiff hand, 70

Case 14 A serious feeding problem, 72

Case 15 Fits, faints and funny turns, 74

Case 16 A hospital acquired infection, 76

Case 17 Recurrent wheeze, 79

Case 18 A jaundiced neonate, 82

Case 19 A febrile boy with a limp, 85

Case 20 A febrile neonate, 87

Case 21 A neonate with abnormal movements, 89

Case 22 A teenager with scrotal pain, 91

Case 23 A boy with nonspecific symptoms, 93

Case 24 A delayed walker, 96

Case 25 A diabetic girl with a headache, 98

Case 26 A boy with sickle cell disease and a fever, 101

Case 27 Negative test results, 104

Case 28 A bad case of ‘flu, 107

Case 29 A difficult transfer, 110

Case 30 Treatment for tonsillitis, 112

Case 31 Increasing respiratory distress, 114

Case 32 A feverish girl with poor feeding, 116

Case 33 An infant with a swollen face, 118

Case 34 Starting a new treatment, 121

Case 35 The importance of interpretation, 124

Case 36 A febrile boy with a scald, 126

Part 3 Investigating and dealing with errors

1 Introduction, 129

2 How hospitals try to prevent errors and their recurrence, 129

3 The role of hospital staff, 134

4 External investigators, 136

5 Hospital investigations, 138

6 Legal advice – where to get it and how to pay, 143

7 External inquiries, 146

8 The role of the doctor, 165

9 Emotional repercussions, 167

10 Conclusion, 169

References and further reading, 169

Index, 171


“My experience as an expert witness in clinical negligence cases, MPTS Panel chairman, medical adviser to a Public Inquiry and as a sometimes commissioned independent reporter on adverse incidents tells me that these are excellent books, valuable for all clinicians, not just those in high-risk specialties; and all NHS managers involved in maintaining or improving the quality of care. The case vignettes, alone, are useful source material for teaching medical trainees on what can go wrong and how to deal with it when it does.” (Harvey Marcovitch, Clinical Risk journal)

"This book is well written and easily read. It is divided into three main parts. The first part deals in general terms with the areas in which errors tend to occur. The importance of good communication, both written and oral, is repeatedly stressed. The contribution of poor management and of system errors in the creation of problems is not overlooked. The section on legal aspects of errors, including discussion of negligence, consent and confidentiality is concise and clear.

The second part consists of thirty-six case studies. These are interesting and thought provoking, with questions for the reader at significant points in the progress of each case. An expert opinion, legal comment and key learning points are given at the conclusion of each case.

Part 3 gives information and advice on responding to complaints, managing mishaps and navigating the hazards of police, court and GMC involvement. Again it is concise and helpful.

After sections 1 and 3, and after every case study in section 2, references and suggestions for further reading are given.

I would strongly recommend this book to all paediatricians, at all levels. It is well structured, easy to read and informative. I would also like to see medical and non-medical managers reading it, as it puts into perspective the role of system failures that so often contribute significantly to clinical errors. I think that general practitioners would also find it well worth reading." (Hilary Haines,  F.R.C.P.C.H., F.F.P.H.)

Pre-publication reviews:
“I think in Medicine it is always best to learn from others’ mistakes rather than waiting until you make your own. In addition, knowing what you can expect if a complaint is made goes some way to emphasising the importance of avoiding errors in the first place. Should a complaint be made, forewarned is forearmed.” (ST1 in Paediatrics)

“The format of presenting “real life” cases with expert clinical and legal commentary is both entertaining and highly informative.” (Consultant Paediatrician)