Aim To determine which clinical errors lead to the referral of paediatricians to the National Clinical Assessment Service (NCAS). This information could result in improvements in medical training and to fewer errors being made.

Methods Data for the 10 year period from 1/4/01-31/3/11 was analysed. Every referral is summarised in the first letter from the NCAS adviser to the referrer. These letters were examined. Referrals are broadly classified into clinical, behavioural and health issues relating to the medical practitioner. Clinical referrals can be general, relating to general deficiencies in knowledge and skills, or specific and concerned with a critical incident. Specific clinical referrals were identified and analysed.

Results There were 259 paediatric cases in this period. There were 110 (42%) clinical concerns in the 259 cases. In 47 (43%) of the 110 cases these were general concerns. There were therefore 63 cases where specific clinical concerns had led to the referral. In 16 (25%) of the 63 cases a patient had died.

The clinical incidents that led to referral to NCAS were: prescribing errors 13, diagnosis other than child protection cases 12, management of child protection cases 10, diagnosis in child protection cases 9, treatment incidents 7, difficulties with transfer of a patient to another unit 6, poor resuscitation 4 and slow response to an emergency 2. Over half, 56%, of clinical concerns related to a consultant paediatrician.

Conclusion This analysis reveals some different errors to those in other studies of paediatric litigation and complaints. Mistakes in child protection cases were the commonest reason for referral to NCAS. Prescribing errors were the second commonest cause. Difficulties in the diagnosis and treatment of a range of different conditions accounted for the next biggest group of referrals. Interestingly, problems with the transfer of patients to other units were a further cause for referrals as was inadequate resuscitation. This study helps highlight areas of paediatrics, such as child protection and prescribing, where training needs to be improved in order to improve patient safety.