Andrea Thirkell

In the circumstances it is my statutory to report to you_ (1) Although considered to be medically fit for discharge at 19.25 hours she did not leave the department until 23.03 and during that time she was not subject to any structured form of monitoring or observation although nursing staff may have seen her during that time: Evidence was given that since this incident staff have been reminded that patients should be subject to formal observations if there is in discharge. Although was told this am unclear as to whether there is a formal trust policy in place in this regard: (2) The deceased did not leave the department until 23.03. Evidence was given that it is common for patients to be discharged late on a night either home or to a care home knowing that there is likely to be nursing care available. evidence heard was that there was no formal trust policy or written guidance with regard to the issue of late at night discharge and what other factors need to be taken account of in considering whether it is safe to discharge a patient at such time and in what circumstances. evidence was that each senior doctor will apply his or her own medical discretion and combined with the pressures on a department am concerned that this could lead to inconsistent or potentially erroneous decisions being made: injury; day: duty delay The The busy