OA18 Giant cell arteritis-related harm: a retrospective analysis of litigation claims data from England for the Getting It Right First Time programme

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Abstract Background/Aims Delays in the diagnosis and management of giant cell arteritis (GCA) can lead to irreversible visual loss. If preventable harm arises, litigation claims may be pursued. We used GCA-related litigation across NHS providers in England to identify trends, patterns of harm and opportunities to improve care. Methods Data on the number and cost of claims across all specialties were extracted from NHS Resolution for the period 2018/19-2022/23, using free-text keyword searches for “giant cell arteritis” and “GCA”. Comparisons were made with data from 2013/14-2017/18, as published in the 2021 Rheumatology GIRFT report. The relationship between providers reporting the presence of a formal GCA pathway in a 2018 GIRFT survey and the occurrence of litigation was explored using χ² testing. Free-text claim data were thematically analysed to identify reasons for litigation and generate learning insights. Results The number and cost of claims approximately doubled between 2013/14-2017/18 (n = 22; £6.6 million) and 2018/19-2022/23 (n = 44; £13.1 million). The most common injury was blindness or visual loss (n = 40/44, 91%). Most claims related to delayed or failed diagnosis (n = 38, 86%). The primary specialties involved were ophthalmology (n = 22), emergency medicine (n = 8), rheumatology (n = 3), and general medicine (n = 3), with single cases in neurology, respiratory medicine, urology, and dermatology. There was no evidence of an association between the presence of a formal GCA pathway and whether a hospital had experienced litigation (p = 0.733). Conclusion GCA-related litigation doubled in frequency and cost in 2018/19-2022/23 compared with the preceding five years. Delays in diagnosis and treatment were the predominant underlying causes, with blindness being the most frequent and severe consequence. Litigation data likely under-represent the true burden of harm, emphasising the need for improvements in early diagnosis, prompt initiation of treatment, and enhanced cross-specialty collaboration. Increasing awareness among all front-line healthcare professionals who may assess people with symptoms of GCA and the actions required, supported by clear and accessible national pathways, has the potential to reduce both patient harm and the burden of litigation in this high-risk condition. Disclosure R.D. Sandler: None. W.K. Gray: None. T.W.R. Briggs: None. N. Dunkley: None. J.T. Machin: None. L. Martin: None. F. McErlane: None. L.J. Kay: None. P.C. Lanyon: None.

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