Source · Prevention of Future Deaths

John Dack

Ref: 2015-0151 Date: 19 Feb 2015 Coroner: ME Hassell Area: London Inner (North) Responses identified: 1 / 1 View PDF

Critical administrative failures, specifically incorrect patient addresses in medical notes despite multiple notifications, led to missed follow-up appointments and have previously resulted in serious consequences.

Date 19 Feb 2015
56-day deadline 16 Apr 2015 est.
Responses identified 1 of 1
Hospital Death (Clinical Procedures and medical management) related deaths

Coroner's concerns

AI summary
Critical administrative failures, specifically incorrect patient addresses in medical notes despite multiple notifications, led to missed follow-up appointments and have previously resulted in serious consequences.
View full coroner's concerns
The MATTER OF CONCERN is as follows.

Mr Dack was not called for follow up because his medical notes recorded the wrong address for him, despite the fact that one of his daughters had notified staff of this on two separate occasions. What seems at first blush to be a relatively unimportant administrative matter can therefore have serious consequences. I heard from the surgeon treating Mr Dack that this has happened before with other patients. It seems that this part of the system of administration would benefit from review.

(No witness was able to offer any suggestions for changes to the hospital system that might prevent inappropriate early discharge home following MDT meeting on another occasion.)

Responses

1 respondent
Barts Health NHS Trust NHS / Health Body
17 Apr 2015 PDF
Noted

Barts Health NHS Trust investigated the incident and has reminded staff of the importance of accurately changing patient details and the consequences of not doing so. They note that the patient did know about the follow-up appointment. (AI summary)

View full response
Dear Ma' Inquest touching the death of Mr John Dack write in response to your Regulation 28: Report to Prevent Future Deaths, dated 19 February 2015. Your concern was that Mr Dack was not called for follow up because his medical notes recorded the wrong address for despite the fact that one of his daughters had notified staff. Our investigation has concluded that the ward clerk was told to change Mr Dack's address by the patient's nurse A mistake was made however as she recorded him as being of fixed abode We have asked the ward matron to speak to her staff to remind them of the importance of accurately changing patient details and the consequences of not doing so_ This mistake did not however mean that Mr Dack was lost to follow up. On 01 August 2014 an appointment was made for 27 August 2014. Although the address on the appointment system was listed as 'no fixed abode' , it is likely it was sent to his previous address Mr Dack phoned the appointment team on 18 August 2014 to change this appointment as it clashed with another appointment: He was given a new appointment for 03 September 2014. On 30 August 2014 he became acutely unwell and was admitted to University College Hospital on that There was therefore no need for him to attend his appointment at The Royal London as his condition was already being treated: In conclusion, although a clerical error was made by a member of staff, it is clear Mr Dack did know about his follow up appointment: The importance of accurately changing patient details is emphasized to the relevant staff: Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital, The Royal London Hospital; St Bartholomews Hospital and Whipps Cross University Hospital 8 OSABLEQ a'am, him, 'no day: being Jtive _ Mouti 0

Barts Health [HS NHS Trust Thank you for bringing your concerns to my attention: trust that you are assured have taken them seriously and investigated them appropriately.

Report sections

Investigation and inquest
On 30 September 2014, I commenced an investigation into the death of John Dack, aged 58 years. The investigation concluded at the end of the inquest on 17 February 2015.

I made a determination that death was the result of an accident, when Mr Dack fell at home on the morning of 8 July 2014, already compromised by a significant heart condition.

I recorded a medical cause of death of:

1a bronchopneumonia 1b septicaemia 1c fractured left ankle with osteomyelitis (operated) 2 hypertrophic obstructive cardiomyopathy (HOCM)
Circumstances of the death
Mr Dack was admitted to the Royal London Hospital on 8 July 2014, and diagnosed first with a fracture of his right ankle, and then the following day a fracture of his left ankle.

Surgeons were worried about his ability to withstand surgery because of the HOCM and so, on 17 July, he underwent a percutaneous procedure on each ankle. This was successful on the right, but not on the left, and so revision surgery was undertaken on the left on 23 July.

Following a multi disciplinary team (MDT) meeting, Mr Dack was discharged home on 30 July. He was unable to weight bear. He was never seen for his planned follow up at the Royal London Hospital. I do not know whether the outcome would have been different if he had been discharged to a rehabilitation unit rather than home and/or had then been followed up as intended, but it might.

The likelihood is that at some stage towards the end of August, he inadvertently put his left foot to the floor and shifted the ankle out of joint. This led to an infection.

Mr Dack was admitted to the emergency unit of University College Hospital on 31 August with osteomyelitis and failure of the fixation. The metalwork was removed and an external fixator applied, but Mr Dack died on 24 September.
Copies sent to
Care Quality Commission for England

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Report details

Reference
2015-0151
Date of report
19 February 2015
Coroner
ME Hassell
Coroner area
London Inner (North)

Responses identified

Responses identified 1 of 1
All listed responses identified

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 16 Apr 2015 (estimated).

Sent to

Barts Health

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