Prevention of Future Deaths reports · 2022

Rita Flynn

Regulation 28 report to prevent future deaths, reference 2022-0310, written 3 Aug 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report3 Aug 2022
Reference2022-0310
DeceasedRita Flynn
CoronerZafar Siddique
Coroner areaBlack Country
CategoryOther related deaths
Organisation namedThe Royal Wolverhampton NHS Trust
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. 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: 

1.  Chief Executive, The Royal Wolverhampton NHS Trust 
2.  Care Quality Commission (for information only). 

1 

CORONER 

I am Zafar Siddique, Senior Coroner, for the coroner area of the Black Country. 

2 

CORONER’S LEGAL POWERS 

I 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  the  30  May  2022,  I  commenced  an  investigation  into  the  death  of  Mrs  Rita  Flynn. 
The  investigation  concluded  at  the  end  of  the  inquest  on  the  20  June  2022.  The 
conclusion of the inquest was a narrative conclusion as follows: 

The deceased died after developing complications arising from a lung abscess. 

The cause of death was:   

1a   Right Upper Lobe Purulent Abscess (no tumour) 

4 

CIRCUMSTANCES OF THE DEATH 

i)  Mrs Flynn was a 78-Year-old woman who contacted her GP after feeling ill 
with flu like symptoms.  She had a telephone consultation on the 12 January 
2022. 

ii)  She  was  given  antibiotics  and  also  advised  to  take  a  COVID  PCR  test.  

Initially her condition improved and the COVID test was negative. 

iii)  Subsequent Blood tests results later revealed that she had raised potassium 
levels  and  indicators  for  infection.  She  was  directed  to  go  to  New  Cross 
Hospital for further examination on 20 January 2022. 

iv)  After further tests including x-ray and a CT scan, a differential diagnosis   of 
malignancy or infection was made. She wasn't given any further antibiotics 
at this stage and effectively discharged home for further follow up treatment. 

v)  By the 3 February 2022 her condition declined further, and she complained 
of shortness of breath associated with haemoptysis and was taken to New 
Cross Hospital by ambulance. 

vi)  Further  blood  tests  were  taken  and  before  the  blood  tests  results  were 

1 

[IL1: PROTECT] 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 available she was discharged home on the basis she had a malignancy and 
didn't require immediate admission to hospital.  

vii)  Blood tests later indicated positive signs of infection.  

viii) Her condition declined rapidly and sadly she passed away at home on the 4 

February 2022. 

5 

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  the 
circumstances it is my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows.  –  

1.  Evidence  emerged  during  the  inquest  that  there  were  clear  indicators  of  an 
infection and before being discharged home by the hospital, it would have been 
best practice to wait for the blood tests results. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you have the 
power to take such action.  

1.  You  may  wish  to  consider  reviewing  your  policy  and  guidance  on  discharge  of 
patients before blood test results are known particularly where there is evidence 
of infection indicated. 

2. 

In addition, where test results indicate evidence of infection and the patient has 
been  discharged  home,  then  consideration  should  be  given  to  contacting  the 
patient at home urgently for follow up review. 

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 3 October 2022. 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. 

8 

COPIES and PUBLICATION 

I  have  sent  a  copy  of  my  report  to  the  Chief  Coroner  and  to  the  following  Interested 
Persons; Family, CQC. 

I 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. 

9 

 3 August 2022                                              

2 

[IL1: PROTECT] 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Mr Zafar Siddique
Senior Coroner 
Black Country Area 

3 

[IL1: PROTECT]

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 The Royal Wolverhampton (PDF)
Your Ref:  

Date: 30th September 2022 

Mr Z Siddique  
H M Senior Coroner  
Black Country Coroner’s Court 
Jack Judge House 
Halesowen Street 
Oldbury 
B69 2AJ 

Dear Mr Siddique  

Inquest –     Ms Rita Flynn – deceased  

I refer to the death of patient Ms Flynn, this matter was heard before your court following an inquest hearing 
on the 20th June 2022.  I am writing to you to respond to the Regulation 28 Notice to received on the 16th 
August 2022, addressed to the Trust’s Chief Executive. 

As  Chief  Medical  Officer,  I  have  instructed  the  Directorate  Management  team  within  the  Emergency 
Department to attend to your concerns raised upon hearing the evidence and more importantly in conjunction 
a  joint  plan  of  actions  has  been  drafted  attending  to  the  issue  as  discharge  of  patients  without  blood  test 
results in particular, where such results are indicative as to an infection. In response the Divisional team have 
attended to the specific tasks raised to address the following: 

1.  To consider reviewing your policy and guidance on discharge of patients before blood test results are 

known particularly where there is evidence of infection showed. 

2.  In addition, where test results show evidence of infection and the patient has been discharged home, 
then consideration should be given to contacting the patient at home urgently for follow up review. 

Review of policy/discharge guidance 

 
 
 
 
 
 
 
 
 
 
 
 
 
 •  Training 

There has been an agreed plan within ED to incorporate within the training portfolio of postgraduate 
doctors, the importance of an initiative-taking and proactive review of blood results prior to discharge of 
patients.  Such training will be delivered at induction level.  

Senior Consultants within the team who deliver individual training needs, as such will disseminate to 
postgraduate staff the importance of reviewing blood results in adhering to discharge protocol. 

•  Documentation 

An ED clerking document is completed by reviewing staff including Doctors, within the Clerking form a section 
for investigations and results has been incorporated so that such results and investigations are documented. 
All Doctors/Clinicians will complete the investigations review section.  This will be assurance and used as a 
checklist criteria to show evidence that results have been reviewed, as well as results being filed at the time 
they have been seen prior to the discharge of patients.  

•  Electronic recording/Systems 

Consultants on duty will be allocated time within their work plan to review blood results in the Clinical Webb 
Portal - ICE system (system which records all results), to review blood results in a timely manner (within 24 
hours). 

 The above process and plans were agreed following a Divisional meeting held on the 5th September 2022 
and Governance meeting held on the 27th September 2022. The process will be included within the ED 
policy/guidance for the discharge of patient pathway.  

I attach for your attention an action plan devised by the team. The actions have been addressed and evidence 
of actions conducted will follow shortly.   

Yours sincerely 

Chief Medical Officer  

The Royal Wolverhampton NHS Trust

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