Repeated warnings
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25 chains, most recent report first. The order is by date only; there is no ranking of organisations.
- Insufficient social care provision leading to discharge delays
Department of Health and Social Care · National body
8 reports · 3 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report - 3 reports · 2 coronersIdentical hazardConfidence 0.92 · high
- Medically fit patients occupying hospital beds leading to ED overcrowding
Department of Health and Social Care · National body
3 reports · 2 coronersIdentical hazardConfidence 0.90 · high - 2 reports · 2 coronersIdentical hazardConfidence 0.90 · highNo published response to an earlier report
- Lack of electronic access to primary care medical notes
Department of Health and Social Care · National body
3 reports · 3 coronersIdentical hazardConfidence 0.90 · high - 2 reports · 2 coronersClosely relatedConfidence 0.90 · high
- Delayed ambulance handover leading to unavailability
Aneurin Bevan University Health Board · NHS body
2 reports · 1 coronerClosely relatedConfidence 0.90 · highNo published response to an earlier report - 2 reports · 1 coronerIdentical hazardConfidence 0.90 · high
- Inadequate paramedic ECG interpretation training
Health and Care Professions Council · Local authority
2 reports · 2 coronersIdentical hazardConfidence 0.92 · high - Excessive ambulance handover delays at hospitals
Welsh Ambulance Service NHS Trust · Ambulance service
3 reports · 3 coronersClosely relatedConfidence 0.90 · high - Delay in reporting original x-ray findings to clinicians
Department of Health and Social Care · National body
2 reports · 2 coronersIdentical hazardConfidence 0.90 · high - Delayed ambulance response to critically unwell patient
Welsh Ambulance Service NHS Trust · Ambulance service
3 reports · 3 coronersClosely relatedConfidence 0.90 · high - Inadequate patient handover practices
Welsh Ambulance NHS Trust · Ambulance service
2 reports · 2 coronersClosely relatedConfidence 0.90 · high - Lack of risk assessment for missing persons
Birmingham and Solihull Mental Health NHS Foundation Trust · NHS body
2 reports · 1 coronerClosely relatedConfidence 0.90 · high - Ambulance fails to document refusal consent
West Midlands Ambulance Service · Ambulance service
2 reports · 2 coronersClosely relatedConfidence 0.90 · high - Ambulance resource shortage delays urgent patient transfers
East Midlands Ambulance Service · Ambulance service
2 reports · 2 coronersClosely relatedConfidence 0.90 · high - Inadequate adrenaline dose in autoinjectors
Medicines and Healthcare products Regulatory Agency · National body
2 reports · 2 coronersIdentical hazardConfidence 0.95 · high - Petrol based emollient cream fire risk
Care Quality Commission · National body
2 reports · 2 coronersClosely relatedConfidence 0.90 · high - Patient flow problems leading to ambulance handover delays
Welsh Ambulance Service NHS Trust · Ambulance service
2 reports · 2 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report - Missing fire hazard warnings on emollient cream packaging
Medicines and Healthcare products Regulatory Agency · National body
2 reports · 2 coronersIdentical hazardConfidence 0.90 · highReviewed dossier