Source · Prevention of Future Deaths

David Mountain

Ref: 2014-0554 Date: 24 Dec 2014 Coroner: Jacqueline Lake Area: Norfolk Responses identified: 1 / 1 View PDF

Post-pacemaker insertion, chest pain and bleeding risks were not fully investigated for days, with a critical echocardiogram delayed and its results unavailable before the patient's death.

Date 24 Dec 2014
56-day deadline 18 Feb 2015 est.
Responses identified 1 of 1
Hospital Death (Clinical Procedures and medical management) related deaths

Coroner's concerns

AI summary
Post-pacemaker insertion, chest pain and bleeding risks were not fully investigated for days, with a critical echocardiogram delayed and its results unavailable before the patient's death.
View full coroner's concerns
_ Despite having had a permanent pacemaker inserted on 20 June 2014 and Mr Mountain developing chest pain on 21 June 2014, the risks recognised on (he consent form, including risk of bleeding and vascular damage were not fully investigated and an Echocardiagram was not performed until afternoon of 23 June 2014. The results, which showed a mild to moderate bleed around the heart, were not available until after Mr Mountain's death:

Responses

1 respondent
The Queen Elizabeth Hospital NHS / Health Body
12 Feb 2015 PDF
Action Taken

The Queen Elizabeth Hospital has implemented clear guidance for doctors on investigating patients admitted after pacemaker insertion and implemented a system for cardiac technicians to directly contact clinical teams about abnormal results. The hospital is moving to an electronic reporting system and cardiology consultants are routinely present on site on weekends. (AI summary)

View full response
Dear Ms Lake; am responding to the Regulation 28 report dated the 24t December 2014 which was received by the Trust o the 29th December 2014 in relation to the on-going investigation into the death of Mr David John Mountain can confirm that the organisation has undertaken a detailed analysis of the circumstances of Mr Mountain's death; All clinicians involved in his care have been spoken to and a number of immediate changes have been made: The Cardiology team are implementing clear guidance for all doctors within the Emergency Department, the Medical Assessment Unit and the Surgical Assessment Unit which highlights the clinical areas which should be investigated if patient admitted following recent permanent pacemaker insertion: This guidance will be shared with the relevant senior clinical decision makers and in place by the end of February 2015. In the event that any abnormal results are identified; the cardiac technician now directly contacts the referring clinical team in hours (or the on-call Medical Registrar out of hours) thus enabling prompt clinical response to be made. Alongside this, we are moving to an electronic reporting system for all test results including echocardiography. Scoping of this major IT project has commenced and we anticipate that it will be in place by the end of 2015_ This will allow doctors access to reports immediately when are entered onto the system and will eliminate the need to transfer a paper copy report from one area of the hospital to another.
3. Cardiology Consultants are now routinely present on site on Saturday and Sunday to review cardiology patients and provide advice to all clinical teams within the Hospital. Chalr: Edward Libbey Interim Chlef Executivc: Manjit Obhrai Patron: Her Majesty The Queen 315434+9 0mmj705^404 #RaN FEB - 2015 key they

13 February 2015 The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust This is an important part of the Trust's move to 7 services and ensures that senior decision making can occur every of the week. The planned recruitment in the next six months of further joint appointments (QEH/ Papworth) will make cardiology services sustainable for the future at the Queen Elizabeth Hospital: would be grateful if you could pass on my condolences to Mr Mountain's family and my apologies for any additional distress which has been caused to them at this difficult time. hope that this information is sufficient to answer your outstanding concerns but if you have any further queries, please do not hesitate to contact me.

Report sections

Investigation and inquest
On 26 June 2014 commenced an investigation into the death of DAVID JOHN MOUNTAIN, Aged 71 years. The investigation concluded at (he end of the inquest on 22 December 2014_ The conclusion of the inquest was medical cause of death: Ia) Haemopericardium and Pericarditis b) Myocardial Perforation c) Pacemaker Insertion for complete Heart Block Aortic Stenosis Conclusion: Recognised risk of a necessary medical procedure.
Circumstances of the death
Mr Mountain was found incidentally to have a slow heart rate. He was referred to Queen Elizabeth Hospital (QEH) on 13 June 2014. Following investigation this was confirmed and as he was found to be at high risk of developing heart failure, he was admitted to Cardiology Ward and recommended for permanent pacemaker implant: Risks were explained to him He was transferred to Papworth Hospital on 20 June 2014. Procedure performed without any recognised complications_ Mr Mountain was reviewed following procedure on 21 June 2014 and chest x ray raised no concerns. Mr Mountain was discharged: On way home he developed chest pain and was taken directly to QEH: Started on antibiotics for sepsis of unknown source He deteriorated and died on 23 June 2014
Action should be taken
In my opinion action should be taken to prevent future deaths and believe your organisation have the power to take such action:

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Report details

Reference
2014-0554
Date of report
24 December 2014
Coroner
Jacqueline Lake
Coroner area
Norfolk

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: 18 Feb 2015 (estimated).

Sent to

Queen Elizabeth Hospital

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