Testicular torsion: the latest HSIB investigation

The Health Service Investigation Branch (HSIB) published a report last week on the sad case of a young student who had to have his testicle removed after numerous delays in diagnosing him with testicular torsion.

The HSIB is modelled on the Air Investigation Branch, which investigate air crashes, and was created to objectively investigate aspects of healthcare and to suggest areas for improvement. The investigation in question looked closely at human factors and analysed the processes and procedures involved to see whether they might have contributed to any deficiencies in care.

The HSIB team does not assign blame, but instead aims to constructively improve the organisation and delivery of healthcare. In a nutshell, the outcome of any investigation is to make it easier for medical teams and administrators to do their jobs correctly. Depending on what the team uncover this may be achieved by putting better resources, systems and procedures in place, or sometimes by improving teamwork and communication. However, the overall aim is to decrease risk of error and support teams to perform to their best, allowing high quality care to happen consistently.

The report concentrated on the community aspects of the testicular pain pathway, which has been described previously in Trends. As a result of thorough investigation into this part of the pathway, the HSIB team managed to enact a number of changes that will greatly help future patients. For example, NHS 111 has redesigned the questions and prompts that were posed to callers with testicular pain, while the Royal College of GPs has agreed to convene a group to standardise the process and communication between practices running urgent telephone services and emergency departments. NICE has also agreed to improve the online guidance on testicular torsion and scrotal pain to make it accessible to patients and their carers, as well as clinicians.

Urology teams should be encouraged to read the HSIB report and be reassured about the professionalism and the anonymity under which a HSIB investigation is carried out and published. News companies often seek to perpetuate ‘the blame culture’ with sensational headlines, but this is not the remit of the HSIB. We would therefore encourage anyone approached to take part in such an investigation, as with the support of the HSIB and its aligned organisations we can improve the care we can deliver to urology patients.

Hopefully this is the first of many such investigations in urology! What are your thoughts? Is there another area in urology that would benefit from a HSIB investigation? If so, then the HSIB is always looking for subjects to investigate where they can make healthcare safer. You can contact them via their website

Comments (3) Add yours ↓
  1. Hannah Warren Urology Registrar

    It is reassuring to see such a constructive response to a serious adverse medical incident. I hope that people are encouraged by this process and refer new areas for improvement to HSIB.

    According to data from NHS England there are a staggering 45 thousand calls handled by NHS 111 per day, so changes to their questions and responses to callers has huge potential for impact. Let’s hope we see more men and boys presenting earlier with testicular torsion!

    September 22, 2019 Reply
  2. Greg Shaw Consultant urologist

    Boys should be taught at school that testis pain is an emergency. Probably around the time that sex education is taught. Late presentation is too frequently an issue with poor outcome after torsion.

    September 25, 2019 Reply
  3. Asif Muneer Consultant Urologist

    Educating youngs boys is key to prevent unnecessary delays. My understanding is that information regarding testicuar self examination is given. It would be easy to extend this to acute scrotal pain and even phimosis. Early diagnosis of lichen sclerosus will prevent late presentation of penile cancer.

    November 5, 2019 Reply

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