Repeated warnings
Each one is a single concern, raised with the same organisation in two or more coroners' reports at least six months apart. Nemotron Super judged every match to be the same or a closely related hazard, and both quotes are checked word for word against the reports.
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At least
108 chains, most recent report first. The order is by date only; there is no ranking of organisations.
- 2 reports · 2 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report
- 2 reports · 2 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report
- Inadequate note keeping of nasogastric tube placement
Department of Health and Social Care · National body
4 reports · 3 coronersClosely relatedConfidence 0.90 · highNo published response to an earlier report - 2 reports · 2 coronersClosely relatedConfidence 0.86 · high
- 2 reports · 2 coronersClosely relatedConfidence 0.85 · highNo published response to an earlier report
- Inadequate nursing staffing affecting wound care and fall prevention
Aneurin Bevan University Health Board · NHS body
2 reports · 2 coronersClosely relatedConfidence 0.80 · moderateNo published response to an earlier report - Incomplete patient transfer information
NHS England · National body
2 reports · 1 coronerClosely relatedConfidence 0.85 · high - 2 reports · 2 coronersClosely relatedConfidence 0.80 · moderate
- Incomplete national early warning system scoring
Brighton and Sussex University Hospitals NHS Trust · NHS body
3 reports · 1 coronerClosely relatedConfidence 0.85 · high - Communication failures between mental health liaison team and acute hospital
Brighton and Sussex University Hospitals NHS Trust · NHS body
2 reports · 1 coronerClosely relatedConfidence 0.85 · high - Unnecessary patient transfers without proper documentation
Brighton and Sussex University Hospitals NHS Trust · NHS body
3 reports · 1 coronerClosely relatedConfidence 0.80 · moderateNo published response to an earlier report - 2 reports · 2 coronersClosely relatedConfidence 0.85 · highNo published response to an earlier report
- Inadequate record keeping and retention compromising care
Blackpool Teaching Hospitals NHS Foundation Trust · NHS body
3 reports · 3 coronersClosely relatedConfidence 0.82 · moderateNo published response to an earlier report - Lack of continuity of care due to excessive care team members
Norfolk and Suffolk NHS Foundation Trust · NHS body
2 reports · 1 coronerIdentical hazardConfidence 0.92 · high - 3 reports · 3 coronersClosely relatedConfidence 0.80 · moderateNo published response to an earlier report
- 5 reports · 1 coronerClosely relatedConfidence 0.80 · moderateNo published response to an earlier report
- Lack of national guidelines for post-procedure monitoring after nerve block
Royal College of Surgeons · National body
2 reports · 2 coronersClosely relatedConfidence 0.80 · moderate - 2 reports · 1 coronerClosely relatedConfidence 0.80 · moderate
- Missed breech presentation due to lack of routine prenatal scanning
Department of Health and Social Care · National body
2 reports · 2 coronersIdentical hazardConfidence 0.92 · highNo published response to an earlier report - Incompatible IT systems hinder clinical information exchange
Stockport NHS Foundation Trust · NHS body
2 reports · 2 coronersClosely relatedConfidence 0.85 · highNo published response to an earlier report