Source · Prevention of Future Deaths
Dennis Warner
Ref: 2019-0470
Date: 28 Jan 2019
Coroner: Sean Cummings
Area: London (West)
0 responses identified · 2 indexed addressees
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AI-generated concerns summaryThe coroner identified inadequate assessment of a patient's capacity to comprehend discharge information due to advanced dementia. Concerns also included delays in X-ray review and insufficient attempts to recall the patient, given challenges in contacting them and their GP.
Date
28 Jan 2019
56-day deadline
25 Mar 2019
stated in the report
Responses identified
0 of 2
Coroner's concerns
The coroner identified inadequate assessment of a patient's capacity to comprehend discharge information due to advanced dementia. Concerns also included delays in X-ray review and insufficient attempts to recall the patient, given challenges in contacting them and their GP.
View full coroner's concerns
(1) Mr Warner suffered from advanced dementia and was the main carer for his elderly wife who also suffered with dementia. He was given information about managing his injury on discharge which he was demonstrably unable to comprehend or remember. Specifically, it was recorded by the examining clinicians that he was unable to answer any orientation questions or to remember the reason for his being in hospital.
(2) The Emergency department was full beyond capacity and he was examined in a meeting room as no cubicles were available (3) chest xray was performed. I heard in written evidence from a Consultant in Emergency Medicine that chest xray is a suboptimal modality for imaging the chest after injury often underestimating both the number of rib fractures and the extent of any intrathoracic injury(4) there was a delay in senior clinician review of the chest xrays after reporting and a passive approach to contacting Mr Warner was taken by the reviewing clinician. An incorrect number was held for Mr Warner but even if contact had been made then he would have had difficulty comprehending and retaining the information; attempts to contact to contact the GP by phone were abandoned because the phone was not answered. A letter was sent which described as misleading. Consequently the efforts made to contact and recall the patient were inadequate.
(2) The Emergency department was full beyond capacity and he was examined in a meeting room as no cubicles were available (3) chest xray was performed. I heard in written evidence from a Consultant in Emergency Medicine that chest xray is a suboptimal modality for imaging the chest after injury often underestimating both the number of rib fractures and the extent of any intrathoracic injury(4) there was a delay in senior clinician review of the chest xrays after reporting and a passive approach to contacting Mr Warner was taken by the reviewing clinician. An incorrect number was held for Mr Warner but even if contact had been made then he would have had difficulty comprehending and retaining the information; attempts to contact to contact the GP by phone were abandoned because the phone was not answered. A letter was sent which described as misleading. Consequently the efforts made to contact and recall the patient were inadequate.
Report sections
Investigation and inquest
Inquest into the death of Dennis Peter Alfred Warner
Circumstances of the death
Mr Warner died at the West Middlesex University Hospital (WMUH) on the 6th December 2016. He had fallen at his home address in Trowbridge on the 18th November 2016 injuring his chest. He attended his local Accident and Emergency Department at the Royal United Hospital Bath on the 19th November 2016 and was discharged the next day with analgesia. He then went to stay with his son in London. He was admitted to the WMUH on the 30th November 2016 with increasing thoracic pain and died from multiple organ failure arising from complications of his chest injury. The recorded Conclusion was of Accidental Death.
Action should be taken
To address the particular concerns and to review how elderly patients with dementia are communicated with and to review appropriateness of imaging techniques in the Emergency Dept.
Similar PFD reports
Report details
- Reference
- 2019-0470
- Date of report
- 28 January 2019
- Coroner
- Sean Cummings
- Coroner area
- London (West)
Responses identified
Responses identified
0 of 2
2 responses not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 25 Mar 2019 (stated in the report).
Sent to
- Care Quality Commission
- Royal United Hospital