Prevention of Future Deaths reports · 2015

Kelly Willis

Regulation 28 report to prevent future deaths, reference 2015-0122, written 30 Mar 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report30 Mar 2015
Reference2015-0122
DeceasedKelly Willis
CoronerRachel Redman
Coroner areaKent (Central & South East)
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedEast Kent Hospitals University NHS Foundation Trust
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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

Mr S Bain

Chief Executive

East Kent Hospitals University NHS Trust
Kent and Canterbury Hospital

Ethelbert Road

Canterbury CT2 3NG

1 | CORONER

| am Rachel Redman Senior Coroner, for the Coroner area of Central and South East
Kent.

2 | 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.

3 | INVESTIGATION and INQUEST

On 15 September 2014 | commenced an investigation into the death of Kelly Patrick
WILLIS. The investigation concluded on 25 March 2015. | reached a narrative
conclusion, a copy of which is attached.

4 CIRCUMSTANCES OF THE DEATH

Kelly Patrick Willis underwent ablation for atrial fibrillation at St Thomas’ Hospital on
8! October 2012. He was discharged the following day. Dr [J the Consultant
Cardiologist and Electrophysiologist who operated on him emailed Dri
Consultant Cardiologist at William Harvey Hospital on 10‘ October and advised her
that if Mr Willis began to feel unwell after a period of one week that he should be
contacted to exclude ‘rare complications (e.g. atrial oesophageal fistula)’.

Mr Willis developed symptoms of general unwellness which required him to be
admitted to William Harvey Hospital on 14" October, 22"4 October and 25'" October.
On the first and third admission it was noted on admission that he had undergone a
procedure at St Thomas’ Hospital who should be contacted. In spite of this
documentation, it was not until Dr] reviewed the patient on 29" October
that contact was made with St Thomas’ Hospital. Dr [J was unable to account for
when she read Dr [iiemail and the Ward Clerk, at the end of the second
admission, was requested to fax a copy of the Electronic Discharge Notification to St
Thomas’ Hospital but failed to do so for a further seven days until 30'" October.

The cause of death was:

1a) Cerebral infarction

1b) Multiple septic emboli

1c) Atrio-oesophageal fistula complicating atrial ablation (08.10.12) for paroxysmal
atrial fibrillation.

CORONER’S CONCERNS

During the course of the inquest the evidence revealed matters giving rise to concern.
In my opinion there is a risk that future deaths will occur unless action is taken. In
these circumstances it is my statutory duty to report to you.

The MATTERS OF CONCERN are as follows.

e Those caring for Mr Willis at William Harvey Hospital recognised the need to
contact St Thomas’ Hospital about the procedure that he had undergone
there but failed to liaise with the tertiary centre before 29'" October, even
though this was well documented in the medical records on the first and third
admissions that it should be. | am of the opinion that contact with the tertiary
centre which had operated on Mr Willis should have been made when he first
presented at William Harvey Hospital on 14" October, and thereafter on 224
October and on 25" October as Dr| had requested.

¢ Dr did not act on the email sent to her by Dr}. Had she liaised
with him it is likely, given his flu-like illness and increasing white cell count,
that he would have been investigated with CT imaging either at St Thomas’
Hospital or William Harvey Hospital at an earlier stage than 29" October, thus
allowing the opportunity to — to exclude rare complications, as he
requested in his email to Dr|

ACTION SHOULD BE TAKEN

e | believe that if it is documented in the medical records that action should be
taken, then that request should be followed.

e | consider that early contact should be made with tertiary centres which have
carried out procedures or treatment in circumstances where their patient is
subsequently admitted to William Harvey Hospital without a confirmed
diagnosis.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report,
namely by 11" May 2015. I, 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
Persons:

Field Fisher Waterhouse LLP

Clyde & Co

DAC Beachcroft

| 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.

Signed: 30 March 2015
Rachel Redman

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 East Kent Hospitals University (PDF)
East Kent Hospitals University NHS)

NHS Foundation Trust
Rachel Redman Trust Offices
HM Coroner Central and South East Kent Kent & air abies
Elphicks Farmhouse Canterbury
Hunton Kent CT1 3NG
Kent
ME15 OSB Tel: 01227 866308
Our Ref:
07 May 2015

From the Interim Chief Executive, fF

Dear Ms Redman
Re: Kelly Patrick WILLIS (deceased)

Following the conclusion of the Inquest hearing touching upon the death of Kelly Willis on 25th
March 2015 and pursuant to Paragraph 7, Schedule 5 of the Coroners and Justice Act 2009, and to
Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013, | set out below the
actions and considerations taken by East Kent Hospitals University NHS Foundation Trust in
respect of your findings.

1. Follow up of documented actions

There are regular, daily handover sessions between the separate clinical and nursing staff when
there is a change over in shift pattern of staff covering the hospitals' sites. During these handover
sessions it is expected that staff inform those coming on duty of any outstanding actions to be taken
in respect of the individual patients on the wards. This includes informing staff of the importance of
following up any actions which remain outstanding at the time of handover. In addition, clinical staff
are expected to review the more recent entries within a patient's healthcare record at the time when
they attend to a patient, in order to ensure that they are aware of the pre-existing documentation
within the patient's healthcare records and to assist in informing future clinical decisions which may
need to be taken. At the time when reviewing the healthcare records, and where it is observed that
an action is outstanding, consideration is given as to the appropriateness of furthering the action in
view of the patient's current clinical condition. Where there is concern as to the appropriateness of
following up a documented action, it is my expectation that the individual's concerns are escalated
to a senior member of staff for further consideration/discussion. Any revisions to action plans
should be clearly documented within the healthcare records to not only record the care decided
upon and given, but also to inform future decision making and on-going treatment plans.

2. Prompt Contact with Tertiary Referral Centres

The Trust recognises that earlier contact should have been made with a St Thomas'
Hospital following Mr Willis' admission to the William Harvey Hospital, particularly because his
diagnosis was unconfirmed. It is not uncommon for patients to undergo treatment at tertiary centres
and for their care to subsequently be referred back to that of the Trust either as a direct referral or
following readmission to hospital from the community setting, as in Mr Willis' case. It is not

ihe

Putting vatients first

Rachel Redman
07 May 2015
Page 2

appropriate or necessary for contact with tertiary centres to be made for all patients who
subsequently return to our care, but it is appropriate in circumstances where patients suffer rare
complications of procedures which they have undergone, such as in the case of Mr Willis. | fully
understand that had timely contact been made with i Mr Willis may have been offered
further treatment for his condition and whilst the prognosis of long term survival would have been
poor, he may have received alternative clinical care and management.

In order to bring your concerns to the attention of the clinical and nursing staff within the Trust an
article will be included in the regular publication produced by the central Risk Management Team
entitled Risk Wise. This publication is disseminated electronically to all members of Trust staff and
is produced on a quarterly basis. The article will include reminders to all staff of the importance of
ensuring that requested actions which are either documented within the healthcare records or
advised of during handover sessions, and which appear to be outstanding at the time of review are
reassessed with a view to subsequent completion. The article will also inform the reader of the
importance of considering the need to make contact with tertiary treatment centres for further
guidance and patient management, particularly where a patient has already received treatment from
that centre. A copy of the published bulletin will be sent to you in due course.

| would like to take this opportunity to thank you for your letter and to reassure you that we have
taken your comments on board and will continue our commitment to deliver a safe and effective

service to our patients.

Yours sincerely

Interim Chief Executive

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