Source · Prevention of Future Deaths
Diana Reay
Ref: 2021-0309
Date: 15 Sep 2021
Coroner: Emma Serrano
Area: Stoke-on-Trent & North Staffordshire Coroner’s Court
0 responses identified · 1 indexed addressee
View PDF
AI-generated concerns summaryConcerns were raised that numerous doctors incorrectly interpreted scans, mistaking a fluid-filled cyst for a full bladder. This led to unnecessary re-catheterisations of the patient.
Date
15 Sep 2021
56-day deadline
12 Nov 2021
stated in the report
Responses identified
0 of 1
Coroner's concerns
Concerns were raised that numerous doctors incorrectly interpreted scans, mistaking a fluid-filled cyst for a full bladder. This led to unnecessary re-catheterisations of the patient.
View full coroner's concerns
(1) Numerous doctors failed to interpret the scans that Diana Reay had correctly. It was accepted that they were wrongly interpreted so that a fluid filled cyst was mistaken for a full bladder. This resulted in numerous re-catheterisations of Mrs Reay when this was un-necessary.
Report sections
Investigation and inquest
On 30/03/2021 I commenced an investigation into the death of Diana Iris Joan Reay, aged 79. The investigation concluded at the end of the inquest on 31st August 2021. The conclusion of the inquest was Diana Iris Joan Reay passed away on the 11 March 2021 at the Royal Stoke University Hospital, Stoke-on-Trent from an acute kidney injury. This was caused by sepsis and community acquired pneumonia. The Medical Cause of death was found to be: 1a) Acute kidney injury. 1b) Sepsis. 1c) Community acquired pneumonia. II) Fascioscapulohumeral dystrophy
Circumstances of the death
The circumstances of the death are that Diana Reay was transferred from the County Hospital to the Royal Stoke University Hospital, Stoke-on-Trent on the 17 February 2021. Whilst she was being treated in hospital she was diagnosed with community acquired pneumonia. This led to sepsis and an acute kidney injury. She passed away on the 11 March 2021.
Similar PFD reports
Report details
- Reference
- 2021-0309
- Date of report
- 15 September 2021
- Coroner
- Emma Serrano
- Coroner area
- Stoke-on-Trent & North Staffordshire Coroner’s Court
Responses identified
Responses identified
0 of 1
1 response not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 12 Nov 2021 (stated in the report).
Sent to
- Royal Stoke University Hospital