Prevention of Future Deaths reports · 2014

Jude Kliem

Regulation 28 report to prevent future deaths, reference 2014-0464, written 29 Aug 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report29 Aug 2014
Reference2014-0464
DeceasedJude Kliem
CoronerIan Arrow
Coroner areaPlymouth, Torbay & South Devon
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS

This report is made under paragraph 7, Schedule 5, of the Coroners
and Justice Act 2009 and regulations 28 and 29 of the Coroners
(Investigations) Regulations 2013.

Recipients
This report is being set to:
e Secretary of State for Health
Coroner
lam IAN MICHAEL ARROW. Senior Coroner for the area of Plymouth, Torbay

and South Devon.

Coroner's legal powers

| make this report under paragraph 7, Schedule 5, of the Coroners and Justice
Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations
2013.

Investigation and Inquest

On 3 June 2013 | commenced an investigation into the death Jude Daniel Kliem,
then aged one year. The investigation concluded at the end of the inquest on 8
August 2014.

The cause of death was found to be:

ta Idiopathic Pulmonary Arterial Hypertension

The conclusion of the inquest was that Jude Daniel Kliem died from Natural
Causes.

Circumstances of death

The deceased was being treated at Derriford Hospital in Plymouth. Attempts
were made by different Consultant Doctors to arrange a transfer to Bristol and to
Southampton.

Coroner’s concerns

There appears to have been a breakdown in communication. There could be an
improvement by way of standardisation of documentation

Action should be taken

| would ask you please to review the method of referral of seriously sick patients
between Hospitals so that lines of communication are clear. You may wish to
note that Derriford Hospital has reviewed its processes and made improvements
since the death.

lam attaching supplementary documents.
Your response

You are under a duty to respond to this report within 56 days of the date of this
report, namely by 25 October 2014. |, the Coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken,
setting out the timetable for action. Otherwise you must explain why no action is
proposed.

Copies and publication

| have sent a copy_of_my report to_the Chief Coroner and to the following
Interested — | and fF (family) and

(Trust's Solicitors)

| am also under a duty to send the Chief Coroner a copy of your response.

The Chief Coroner may publish either or both in a complete or redacted or

summary form. He may send a copy of this report to any person who he believes
may find it useful or of interest. You may make representations to me, the

coroner, at the time of your response, about the release or the publication of your
response by the Chief Coroner.

IM ARROW Date 29 August 2014
Senior Coroner — Plymouth Torbay and South Devon area

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Department of Health (PDF)
acl From Dr Dan Poulter MP

@r9 Parliamentary under Secretary of State for Health
Richmond House

Department 79 Whitehall
London

of Health SWIA 2NS

Tel: 020 7210 4850
POCS 884128

Mr I Arrow
HM Coroner
Coroner’s Court
3 The Crescent
Plymouth
PL1 3AB
23"! October 2014

Dear Mr Arrow,

Thank you for your letter following the inquest into the death of Jude Kliem. I was sorry to
read of Jude’s death and wish to extend my sincere sympathies to his family.

Jude was being treated at Derriford Hospital in Plymouth where various attempts were made
by different consultant doctors to arrange for him to be transferred to Bristol and
Southampton hospitals. You are concerned that there appears to have been a breakdown in
communications between the hospitals involved.

You ask that we:

review the standardisation of patient retrieval within the NHS

e review the methods of referral of seriously sick patients between hospitals so that lines
of communication are clear

e consider standardising documentation to improve communication

At the inquest, you heard that changes have already been made by Derriford hospital for the
transfer of paediatric intensive care patients to other hospitals, including the development of
a standard pro-forma referral document. This bring them into line with the policy and
standard practice of most other paediatric intensive care units (PICUs) in England because
of the need to ensure prompt referral and safe transfer of patients who need paediatric
intensive care.

Ihave shared your report with NHS England. I am advised by its clinical experts working in
networks covering both PICUs and PICU retrieval services. Most PICUs already use a pro-
forma for patient referral and retrieval (similar to the pro-forma you provided from Bristol
Royal) to ensure a structured way of communicating the information required. These pro-
forma have been developed either by the individual hospitals or by agreement across a
region. :

There is clearly an opportunity to further improve safety by bringing together the best
aspects of the existing formats into a single document. Such a document would contain the
key content needed for safe and effective referral and retrieval, to which suitable local or

specialist requirements might be added.

In developing such a national document the PICU networks would build on standards and
service specifications already in place, such as ‘The acutely or critically sick or injured child
in the district general hospital - a team response’ (Department of Health, 2006). There is
relevant work currently underway, led by the Paediatric Intensive Care Society’s Acute
Transport Group, on setting standards for the skills and competencies needed by staff who
transfer babies and children in need of PICU.

NHS England intends to take this forward in partnership with the Paediatric Intensive Care
Society. Together, they will work to ensure that a national format is not seen as a stand-
alone solution, but part of a much wider process that facilitates a senior clinical conversation.
The aim is to ensure that both family and clinical concerns are effectively addressed and lead

to agreement on appropriate action.

There are several examples of this being already being done successfully in the NHS, and I
understand that the organisations that were involved in Jude’s care are now working on
introducing a similar model. I have asked my officials to keep you up to date with the
progiess of this work over the coming months.

I hope that this response is helpful and I am grateful to you for bringing the circumstances of
Jude’s death to my attention.

Best wishes,

DR DAN POULTER

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