Stephen Cassidy

19 Sept 2023 · Coroner Simon Fox · Avon

The coroner's concerns

1. lack of routine access to Summary Care Record by SMH clinical staff
“There is no provision for clinical staff at SMH to access patients' Summary Care Record routinely or easily”
2. inconsistent access to patient records between ambulance service and hospital
“This is despite provision existing for SWAS clinical staff to do so before a patient arrives at hospital”
3. absence of automatic allergy display in electronic patient record
“There is no provision for the Summary Care Record to be integrated with SMH's hospital electronic patient record (known as Careflow/Connect) or the primary care electronic patient record (known as EMIS - Egton Medical Information System) - such that the Ceftriaxone allergy automatically appears in SMH's electronic patient record”
4. clinicians unaware of critical patient data
“As a result hospital doctors are ignorant of important clinical information on the patients they are treating”
5. potential for avoidable patient death
“This can lead to avoidable patient harm including death”