Manchester University NHS Foundation Trust
NHS / Health Body
Action Planned
Manchester University NHS Foundation Trust will train Cardiology Residents on using the HIVE system to send discharge letters to relevant healthcare providers and create tip sheets and video guides for cardiology teams, which will be shared across the Trust. (AI summary)
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Dear Ms Morris
The late Mrs Honoria Culshaw – 11 June 1958 – 28 October 2024 Response to Prevention of Future Deaths Report
I am grateful to you for providing us with the opportunity to respond to the concerns which arose during the Inquest into the death of the late Honoria Culshaw, namely “[a] lack for information sharing along a communication pathway between the cardiology department at Wythenshawe and the cardiology departments at local treating hospitals risks such referrals being delayed or not being made at all.”
The team at Manchester University NHS Foundation Trust (‘the Trust’) would like to reiterate our condolences to the family of Mrs Culshaw on their loss.
Actions taken by Manchester University NHS Foundation Trust The introduction in September 2022 of HIVE, the new electronic patient record at Manchester University NHS Foundation Trust, offered the chance for the Trust to develop new processes for communication across health providers, as can often be the case.
Mrs Culshaw was discharged from the Emergency Department at Wythenshawe Hospital on 10 July 2024 following advice from the Cardiology registrar on call concerning her implanted medical device. This advice for further action of referring Mrs Culshaw to Preston Cardiology was documented on the discharge letter and sent to Mrs Culshaw’s general practitioner to action in line with Trust policies in place at that time.
In the UK, discharge letters are traditionally only sent to a patient’s general practitioner. It is possible in the Trust’s electronic patient record system’s (HIVE) functionality to send copies of the discharge summary to additional recipients as well as the general practitioner. This functionality is available in all workflows including those used by the Emergency Department and Cardiology.
A10
Onward communication and referral to external providers have been a key area of focus and improvement for the Trust. Following this case, further work is being done with discharge communications from Emergency Departments to provide structured discharge information and also built in reminders to staff that if a referral is required, the correct process is following at the point of discharge. This includes working with digital colleagues to review the practicalities of amending the current Emergency Department notes that are generated by the Trust.
As part of the rolling programme of improvements of the use of HIVE, the Trust is committed to improve the discharge process in our Emergency Departments to ensure that the workflow is seamless and our clinical teams are aware of the functionality to send copies of Emergency Department discharge letters to a full range of healthcare providers. This would include cardiology departments at providers such as the Royal Preston Hospital.
In keeping with a system approach to patient safety, the Trust is looking to make the process as simple as possible for clinical teams by making workflows seamless and intuitive, and supporting staff training and induction in relation to the discharge processes.
The Trust will also develop additional HIVE tip sheets and video guides to increase knowledge and awareness of the ‘correspondence’ tab in the Emergency Department’s discharge navigator within HIVE. The tip sheets and video guides will be availably by 15 December 2025 and shared with all relevant staff members by this date by the Emergency Department’s Clinical Head of Division.
Once the tip sheets and video guides are available, Emergency Department discharge processes will be incorporated into the normal weekly Resident training sessions and as part of Residents’ Trust Induction. This training will include a topic on communicating with healthcare professionals other than the patient’s general practitioner when it is relevant to do so. The target date for this reaching all current Emergency Department Resident staff at the Trust is 31 January 2026.
This training will be incorporated into Emergency Department Residents’ Induction training in time for the next cohort starting in February 2026. The Emergency Department Trust Specialty Training Lead (TSTL) will amend and update the Induction training package accordingly.
The intention is that the ‘correspondence’ workflow will appear in the ‘Dispo’ section (the discharge navigator for the Emergency Department). This will require a fundamental HIVE build and therefore will not be completed until June 2026.
We have reinforced with the Cardiology Department that communication with other secondary and tertiary care providers is of paramount importance to ensure continuity of care is maximised for patients. From 15 December 2025 onwards when the tip sheets and video guides are available, Cardiology Residents’ training will include focused education regarding the processes available to copy inpatient discharge letters that are sent to general practitioners to other relevant healthcare providers. This uses the same process within the electronic patient record as medical staff use to send letters following outpatient clinic appointments. This training will be A11
incorporated into Cardiology Residents’ Induction training in time for the next cohort starting in February 2026. The Cardiology Trust Specialty Training Lead (TSTL) will amend and update the Induction training package accordingly. The tip sheets and video guides will be shared with all relevant staff members by 15 December 2025 by the Cardiology Clinical Head of Division.
Furthermore, these tip sheets and video guides will ensure that the on-call Cardiology teams are aware of the Permanent Pacemaker Extraction services that are available at Wythenshawe and the indications for referral and how to generate a referral. This will also be covered in the Induction training.
The Associate Medical Director for Quality and Patient Safety will also share the tip sheets and video guides with all the Medical and Nursing Directors across the Trust for more widespread distribution. This will be completed by 15 December 2025.
I trust that this reply has assured you that Manchester University NHS Foundation Trust has taken your concerns seriously and have learned from the events which contributed to Mrs Culshaw’s death.
On behalf of the Trust, I would like once again to offer Mrs Culshaw’s family condolences on their loss.
The late Mrs Honoria Culshaw – 11 June 1958 – 28 October 2024 Response to Prevention of Future Deaths Report
I am grateful to you for providing us with the opportunity to respond to the concerns which arose during the Inquest into the death of the late Honoria Culshaw, namely “[a] lack for information sharing along a communication pathway between the cardiology department at Wythenshawe and the cardiology departments at local treating hospitals risks such referrals being delayed or not being made at all.”
The team at Manchester University NHS Foundation Trust (‘the Trust’) would like to reiterate our condolences to the family of Mrs Culshaw on their loss.
Actions taken by Manchester University NHS Foundation Trust The introduction in September 2022 of HIVE, the new electronic patient record at Manchester University NHS Foundation Trust, offered the chance for the Trust to develop new processes for communication across health providers, as can often be the case.
Mrs Culshaw was discharged from the Emergency Department at Wythenshawe Hospital on 10 July 2024 following advice from the Cardiology registrar on call concerning her implanted medical device. This advice for further action of referring Mrs Culshaw to Preston Cardiology was documented on the discharge letter and sent to Mrs Culshaw’s general practitioner to action in line with Trust policies in place at that time.
In the UK, discharge letters are traditionally only sent to a patient’s general practitioner. It is possible in the Trust’s electronic patient record system’s (HIVE) functionality to send copies of the discharge summary to additional recipients as well as the general practitioner. This functionality is available in all workflows including those used by the Emergency Department and Cardiology.
A10
Onward communication and referral to external providers have been a key area of focus and improvement for the Trust. Following this case, further work is being done with discharge communications from Emergency Departments to provide structured discharge information and also built in reminders to staff that if a referral is required, the correct process is following at the point of discharge. This includes working with digital colleagues to review the practicalities of amending the current Emergency Department notes that are generated by the Trust.
As part of the rolling programme of improvements of the use of HIVE, the Trust is committed to improve the discharge process in our Emergency Departments to ensure that the workflow is seamless and our clinical teams are aware of the functionality to send copies of Emergency Department discharge letters to a full range of healthcare providers. This would include cardiology departments at providers such as the Royal Preston Hospital.
In keeping with a system approach to patient safety, the Trust is looking to make the process as simple as possible for clinical teams by making workflows seamless and intuitive, and supporting staff training and induction in relation to the discharge processes.
The Trust will also develop additional HIVE tip sheets and video guides to increase knowledge and awareness of the ‘correspondence’ tab in the Emergency Department’s discharge navigator within HIVE. The tip sheets and video guides will be availably by 15 December 2025 and shared with all relevant staff members by this date by the Emergency Department’s Clinical Head of Division.
Once the tip sheets and video guides are available, Emergency Department discharge processes will be incorporated into the normal weekly Resident training sessions and as part of Residents’ Trust Induction. This training will include a topic on communicating with healthcare professionals other than the patient’s general practitioner when it is relevant to do so. The target date for this reaching all current Emergency Department Resident staff at the Trust is 31 January 2026.
This training will be incorporated into Emergency Department Residents’ Induction training in time for the next cohort starting in February 2026. The Emergency Department Trust Specialty Training Lead (TSTL) will amend and update the Induction training package accordingly.
The intention is that the ‘correspondence’ workflow will appear in the ‘Dispo’ section (the discharge navigator for the Emergency Department). This will require a fundamental HIVE build and therefore will not be completed until June 2026.
We have reinforced with the Cardiology Department that communication with other secondary and tertiary care providers is of paramount importance to ensure continuity of care is maximised for patients. From 15 December 2025 onwards when the tip sheets and video guides are available, Cardiology Residents’ training will include focused education regarding the processes available to copy inpatient discharge letters that are sent to general practitioners to other relevant healthcare providers. This uses the same process within the electronic patient record as medical staff use to send letters following outpatient clinic appointments. This training will be A11
incorporated into Cardiology Residents’ Induction training in time for the next cohort starting in February 2026. The Cardiology Trust Specialty Training Lead (TSTL) will amend and update the Induction training package accordingly. The tip sheets and video guides will be shared with all relevant staff members by 15 December 2025 by the Cardiology Clinical Head of Division.
Furthermore, these tip sheets and video guides will ensure that the on-call Cardiology teams are aware of the Permanent Pacemaker Extraction services that are available at Wythenshawe and the indications for referral and how to generate a referral. This will also be covered in the Induction training.
The Associate Medical Director for Quality and Patient Safety will also share the tip sheets and video guides with all the Medical and Nursing Directors across the Trust for more widespread distribution. This will be completed by 15 December 2025.
I trust that this reply has assured you that Manchester University NHS Foundation Trust has taken your concerns seriously and have learned from the events which contributed to Mrs Culshaw’s death.
On behalf of the Trust, I would like once again to offer Mrs Culshaw’s family condolences on their loss.