BARNET AND CHASE FARM HOSPITALS NHS TRUST
REPORT TO:
Trust Board
REPORT FROM:
Head of Patient and Public Involvement
Head of Risk
Joint Acting Head of Complaints
REPORT SPONSORED BY:
Director of Nursing
DATE:
9th September 2004
SUBJECT:
Quality and Governance
Annual Report for Complaints;
PALS and Risk quarterly reports.
FOR:
Information / Discussion
_________________________________________________________
1.
EXECUTIVE SUMMARY
This is the Annual Report on Complaints for 2003/2004 and includes
Legal Claims. It also details activity in the first quarter of 2004-2005,
April – June 2004 giving information about compliments, complaints,
claims and PALS (Patient Advice and Liaison Service) issues together
with risk trends.
The data is brought together in an integrated report to give the Board
an all-round look at quality and governance issues in the Trust enabling
them to trace trends across the organisation and to note the action and
learning points distilled and implemented into practice from one report.
The National Patient Safety Agency (NPSA) has set out ‘Seven steps
to patient safety’1. They are:
1.
2.
3.
4.
5.
6.
7.
1
Build a safety culture
Lead and support your staff
Integrate your risk management activity
Promote reporting
Involve and communicate with patients and the public
Learn and share safety lessons
Implement solutions to prevent harm
National Patient Safety Agency, Seven steps to patient safety, an overview guide for NHS staff,
NPSA 2004
In developing an integrated quality and governance approach the
Trust is systematically implementing the seven steps to patient
safety.
2.
RECOMMENDATION
The Board is asked to note this report.
3.
INTRODUCTION
Issues highlighted through Risk Management, PALS (Patient Advice
and Liaison Services) Complaints and Legal Claims are key indicators
of quality and governance in the Trust. Through this integrated report
the Board is presented with information from both an organisational
and a patient-focused perspective.
4.
QUALITY AND GOVERNANCE REPORT
4.2
The Complaints, PALS and Risk teams continue to undergo change.
Pauline Ferns was appointed to the substantive post of Head of Risk,
with effect from 7th July 2004. We are currently recruiting to fill a
vacancy within the risk team created as a result of her appointment.
We were unsuccessful in appointing a Head of Complaints and the
post was re-advertised with a closing date of 26th August for interview
in September. Otherwise the Complaints teams are up to strength on
both sites and a PALS Officer has been appointed to the vacancy at
Barnet PALS starting in October. Kay Laurie, Head of Patient and
Public Involvement is currently line managing both the PALS and
Complaints teams.
At Chase Farm hospital the Complaints and PALS teams re-located in
July to the old flower shop at the main entrance. As this is a much
more accessible location for patients and visitors we expect to see
contacts with the PALS service increase, as they did at Barnet hospital
when the service there relocated from Thames House to a retail unit in
the hospital main entrance.
The Chase Farm site Risk team has also relocated and is now based
on the 2nd Floor of the Clocktower Building along with the Health and
Safety team.
4.3
QUALITY REPORT – Q1 2004/2005 (1 April 2004 – 30 June 2004)
4.3.1 COMPLIMENTS
Letters, cards and donations in appreciation of care and treatment are
received throughout the Trust. Previously, letters of compliment
received by the Chief Executive’s office have been reported in the
complaints report. However as these only represented a small
2
proportion of the overall, we are working with the Head of Fundraising
to achieve a more coordinated approach to acknowledging the support
and generosity of our patients, their families and friends.
Both PALS teams have had a number of people calling in to pass on
praise to staff. Callers are offered ‘employee of the month’ nomination
forms and their messages of appreciation are emailed to the relevant
wards and departments and copied to Matrons and service managers.
The new bedside magazine for in-patients will include a slip for patients
to give feedback and to nominate staff for employee of the month.
4.4
THE COMPLAINANTS ‘PATHWAY’
Across the Trust we are developing a ‘Complainant’s Pathway’ to help
ensure that we are able to make every effort to resolve concerns or
complaints at the earliest possible opportunity. A number of changes
to the way in which complaints and concerns are dealt with have been
introduced, both in the Trust and in response to new regulations. Most
recently, the arrangements for ‘Independent Review’ have changed
and this is covered in more detail later in this report. Further changes
to the ‘local resolution’ process are expected next year following the
publication of the fifth report of the Shipman Inquiry and the Head of
Patient and Public Involvement is participating in development work on
local resolution being undertaken by the Department of Health.
4.4.1 The PALS (Patient Advice and Liaison) Service
Early intervention and speedy resolution
The establishment of the PALS (Patient Advice and Liaison) service in
the main entrances at each hospital has meant that in a significant
number of instances, there is the opportunity for speedy and informal
‘local resolution’ of patients or families concerns.
The PALS services logged 834 first contacts in Quarter 1. They were
categorised into ‘types’ as follows:







Advice or information
Comment or suggestion
How to make a complaint
Concern or complaint
General queries
Health related issues
Praise
All issues raised with PALS are taken seriously. They are recorded,
dealt with and reported to the Trust Board in the same way that formal
complaints are.
3
PALS type Q1 2004/5
500
450
400
Potters Bar Hospital
Number
350
Finchley Memorial
Hospital
Edgware Hospital
300
250
200
Chase Farm Hospital
150
Barnet Hospital
100
50
Ad
v
ic
e/
In
fo
F
H
ow eed
ba
to
C
ck
C
on
o
ce
m
pl
rn
ai
/C
om n
G
en
pl
H
ai
ea era
nt
l
lth
Q
ue
R
rie
el
at
s
ed
Is
su
e
Pr
ai
se
0
This illustrates the range of issues in which the PALS teams are asked
for help and advice. Early intervention can be very effective in sorting
the issue out without the patient or family member feeling it necessary
to resort to the formal complaints procedure.
The next chart compares activity in the PALS and Complaints teams.
These broad categories as used for the performance data gathered by
the Department of Health nationally. For detailed explanation of the
subject categories, see Annex 2, page 26.
4
Complaints and PALS Overview by subject Q1 2004/5
Number
0
100
200
300
400
Adm/Dsch
Aids
Apt Inpt
Apt Outpt
Attitude
Clinical
Communications
Complaints handling
Consent
PALS
Hotel
Others
Complaints
Pt records
Policy
PrivDignity
Procedure
Pts property
Transport
Ind Sector
Code open
Wait response
4.4.2 FORMAL (WRITTEN) COMPLAINTS
The complainant’s right to a formal investigation
A total of 118 formal complaints were made in Quarter 1 2004/5 with
three quarters of these made by the complainant directly to the Chief
Executive. The remainder were complaints in which the PALS teams
had been unable to facilitate a resolution to the complainant’s
satisfaction.
In all cases the complainants may exercise their right to make a formal
complaint, in accordance with NHS complaints guidance requiring that
‘complainants are treated courteously and sympathetically and as far
as possible involved in decisions about how their complaints are
handled and considered’.
5
PALS becoming formal Complaints
PALS
Complaints
Barnet PALS
542
18
Chase Farm PALS
252
10
The percentage of formal (written) complaints where local resolution is
completed within 20 working days is one of the ‘balanced scorecard’
performance indicators for the NHS star ratings.
Number of complaints
Formal Complaints by site Q1 2004-5
70
60
50
40
Barnet Hospital
30
Chase Farm Hospital
20
10
0
1
Site
Performance on formal complaints in the 6 months to March 2004 was
recorded at 72% but this fell to 65% in Q1 2004/5. The Trust target is
to attain a performance for the year of 75%. Because the PALS teams
now resolve the more straightforward issues those issues that go
through the formal process tend to be more complex and may involve
more than one department. Consistently completing local resolution
within 20 days will require close supervision at directorate level.
Complaints Response
Performance Times
Number Number
% response % response Out
Av days
Q1 2004/5
received responded to < 20 days
> 20 days
standing response
Medical & Emergency
53
30
77
7
8
15
Surgical & Anaesthetics
31
20
55
9
6
16
Estates & Facilities
2
2
50
1
0
25
Women's & Children's
22
10
50
5
9
22
Diagnostics Therapies Cancer
10
7
71
2
1
15
Totals
118
69
65%
24%
24
16
It is important to note that under the revised complaints regulations,
from 1st August 2004 complainants may refer any complaint they feel is
not resolved within 6 months to the Healthcare Commission and seek
an Independent Review.
6
The chart below compares the activity on PALS and Complaints for
each of the Clinical Divisions. As can be seen, the ratio of PALS to
formal Complaints is broadly comparable, with somewhat fewer issues
in Women’s and Children’s being addressed via PALS.
PALS vs Formal Complaints Q1 2004/5
Number of issues / complaints
250
200
150
Formal Complaint
PALS
100
50
0
Medicine & Surgery & Estates & Diagnostics Women's &
Emergency Anaesthetics Facilities Therapies Children's
Cancer
Division
4.4.3 INDEPENDENT REVIEW AND OMBUDSMAN
Reforms to the Complaints procedures
The NHS Complaints procedures are part way through a reform
process. New regulations were introduced on 1st August 2004 in
relation to the ‘second stage’ of the Complaints procedure
‘Independent Review’.
Under the ‘old’ system, complainants could ask the Trust for an
Independent Review of their complaint. During 2004 there will be a
transitional period whilst ‘old’ system Independent Reviews are
completed. From 1st August 2004 complainants may ask the
Healthcare Commission (HC) to review their complaint if they are
unhappy with the Trust’s response, or if the Trust has been unable to
7
complete the formal local resolution stage within 6 months. It is
desirable that every effort be made to resolve a complaint to the
satisfaction of a complainant within six months, this is better for
complainants and staff alike and would also minimise the potential for a
referral to the Healthcare Commission.
4.4.4 HEALTHCARE COMMISSION
Listening to both sides of the story
It would appear that the process the Healthcare Commission are
following in reviewing an application is broadly similar to that used by
the Health Services Commissioner (Ombudsman). The Director of
Operations for the Healthcare Commission has stated that:
‘The Commission aims to deliver a fair, consistent and timely
process. Feedback we have received shows that people want a
fair system for both the complainant and the complained
against. We will give both parties the opportunity to put their
side of the story, to agree the terms of reference of any
investigation and to have access to all relevant documentation’. 2
At the end of August, as this Board report was drafted, the Trust had
already been notified of 5 applications for Independent Review that had
been received by the Healthcare Commission. The Healthcare
Commission requires a comprehensive pack of information about the
progress of the complaint so that they can review the matter and
decide what the next step should be. The Trust has two weeks in
which to produce the information required.
In the period 1 April 2003 to 31 March 2004 the following actions were
taken in respect of Independent Review (IR):



21 Request for IR were received
15 Requests were referred back for further local resolution
6 Independent Review Panels have been / are to be held
4.4.5 HEALTH SERVICES COMMISSIONER
The ‘Ombudsman’
If a complainant is dissatisfied about the Independent Review process
or decision, they can ask the Ombudsman to investigate their
concerns. Under the complaints arrangements, there is no further
appeal process after the Ombudsman has considered the complaint.
The Ombudsman’s recommendations are made to Parliament.
2
Speak Out, Marcia Fry, Head of Operations, Healthcare Commission, Health Service Journal, 19
August 2004.
8
Independent Review & Ombudsman
July 2003 - August 2004
0
2
4
6
8
10
12
Request IR (old)
Denied (old)
Request IR (new HC)
Denied (new HC)
Q2 2003/4
Panels held (old)
Q3 2003/4
Q4 2003/4
Panels held (HC)
Q1 2004/5
(Q2 2004/5)
Reports published
Ref Ombudsman
Omb Investigation
Investigation Complete
4.4.6 TRENDS IN PALS AND COMPLAINTS
Ensuring that lessons are learned and shared
A key aspect of quality and governance is to have processes that
enable risk issues to be filtered out and escalated to the right level in
the Trust. We need to ensure that senior staff contribute to the
resolution of such issues and consequent action planning. As the Trust
Complaints Policy is being revised to take into account changes to the
Independent Review processes a discussion paper is being written that
considers how the pro-active risk assessment might be applied to
PALS and Complaints issues. This would link PALS and Complaints
to the existing Trust risk process.
The majority of non-clinical issues centred on estates and facilities –
parking, cleanliness, slips, trips and falls by visitors. Quite some time
was taken up assisting people enquiring about jobs. Financial
enquiries were about reimbursement of fares, parking fees and lost
property.
9
Number of Contacts
PALS Non-Clinical Q1 2004/5
Estates & Facilities
100
90
80
70
60
50
40
30
20
10
0
Finance Directorate
Human Resources
Nursing Directorate
Operations Directorate
Directorate
4.4.7 WHAT WERE THE ISSUES PEOPLE COMPLAINED ABOUT?
When we start to look in detail at the reasons people contacted the
PALS service, or went on to make a formal complaint, we have the
opportunity to target areas for improvement. As we saw earlier, the
patterns are similar, so PALS issues, in particular, may also serve as
an ‘early warning’ of problems on the horizon as they are greater in
number than those which come as formal complaints. The broad
‘subject’ categories that are collected by the NHS indicate the general
issues:
PALS overview by subject Q1 2004/5
Number of contacts
Subject
0
50
100
150
200
250
Adm/Dsch
Aids
Apt Inpt
Apt Outpt
Attitude
Clinical
Communications
Consent
Hotel
Other
Pt records
Policy
PrivDignity
Procedure
Pts Property
Transport
Ind Sector
We collect more detailed information about issues, and the next chart
gives a Trust wide overview of patients concerns.
10
PALS Issues by Subject Q1 2004/5
Number of contacts
0
Accessibility
Att Amin
Att H Prof
Att Medic
Att Midwives
Att Nurses
Blood Tests
Breach Conf
Clled Oper
Clled Op Rpt
Parking
Food
Contacting
Discharge
Environment
Falls
Hyg Clean
Job enq
Acc Med Rec
MRSA
OP apt post
rep OP post
Pain
Pharmacy
Pressure
PrivDignity
Property
Results
Signage
Transport
Fares enq
HP treat
Med treat
Mid treat
Understand
Wait A&E
Wait OP
Wait Apt
Wait Oper
Wait Test
Xray
10
20
30
40
50
60
Diag Therapies & Cancer
Estates & Facilities
Finance
Human Resources
Medical & Emergency
Nursing Directorate
Operations Directorate
Surgical & Anaesthetics
Women's & Children's
11
Detailed descriptions of these categories, together with Directorate or Clinical Divisional data are given at Annex 1, pp 22-25
12
Detailed descriptions of these categories, together with Directorate or Clinical Divisional data are given at Annex 1, pp 22-25
4.4.8 OUTCOMES AND LEARNING
Responding positively to concerns and complaints is essential if we are
to improve our services. For example looking at some of the issues in
the chart above we have taken the following actions:
Parking
- We have reduced the parking charge at Barnet Hospital
from £10.30 to £3 per day and will be publicising the availability of
concessionary £8 weekly tickets through our new inpatient magazine.
Blood tests – We have introduced an appointment system to reduce
long waits at our out-patient blood test clinics. Some GPs have not
been advising patients of the new arrangements and we are contacting
those GPs to ensure that this information is passed on. Patients are
generally much happier with the new system. We have also relocated
the Barnet Hospital blood test clinic to Level 0 so that we could provide
more comfortable facilities for those waiting.
Falls by patients or visitors – Falls are reported on Datix as PALS or
Incidents. A ‘Falls’ project has been set up to address this issue from a
risk management perspective.
4.5
LEGAL CLAIMS
Seeking redress through the Courts
A legal claim may be made through the civil courts by a patient or their
family against the Trust. If the matter was previously being
investigated as a complaint then the complaints procedure is
suspended. Sometimes matters move very quickly into the legal
process, others may become legal claims only after several years. In
the case of a claim for damages to a child this may occur at any time
before the child reaches 25 years of age.
4.5.1 Trends in Legal Claims
The total number of claims received in 2003/4.was 83 with the highest
number in one quarter being 17 arriving in Q3 (October to December
2003).
13
Claims 2004/5 by Speciality
Total = 83
0
2
4
6
8
10
A&E
Gen Surgery
Gynae
Histopathology
Gen Medicine
Geriatric
Q1 Total
Paed med
Q2 Total
Mental Health
Q3 Total
Non Clinical
Q4 Total
Obstetric
Opthalmology
Orthopaedic
Pathology
Radiography
Vascular
4.5.2 Current Legal Claims
At 30 June 2004 there were altogether 154 legal claims at various
stages in the process. The legal process can take several years to
conclude during which time the cases remain open. In the following
tables information is presented firstly on the number of claims on each
site by clinical specialty. The second graph indicates how these have
been coded using the NHS Litigation Authority numbering system to
identify the type of incident.
14
Live Claims at 30 June 2004
Number
0
10
20
30
40
50
A&E
Dermotology
Day Hospital
ENT
Gastro
General Surgery
Gynae
Histology
Specialty
General Medcine
Barnet Hospital
Chase Farm Hospital
Edgware Hospital
Geriatric Medicine
Paediatric Med
Non Clinical
Obstetrics
Oncology
Opthalmology
Orthopaedics
Pathology
Radiography
Surgical Other
Surgical Paeds
Urology
On the next page we show the numbers of current legal claims and the
type of incident concerned. These are all the legal cases that were
open at 30th June 2004.
The codes for these incidents are set by the NHS Litigation Authority
and reflect the varied types of legal claims that are made. The list of
codes is given in full in Annex 3, page 27.
15
Number
Live Claims at 30 June 2004 by Incident Type
O755
O740
O660
O650
O600
O550
O540
O520
O510
G240
G220
G190
G180
G170
G160
G140
G130
G120
G110
G090
G080
G070
G050
G040
G030
G020
G010
BD
A840
A820
999
998
790
680
Barnet Hospital
Chase Farm Hospital
Edgware Hospital
0
10
20
30
40
50
Incident Type
4.5.3 New legal claims
In Q1 of 2004/05 (1st April 2004 – 30th June 2004) a total of 23 new
legal claims were received by the Trust:
16
Q1 2004/05 New Claims by Specialty
Number
0
2
4
6
8
Dermotology
ENT
Gastro
Gen Survery
Gynae
Specialty
Gen Medicine
Barnet Hospital
Chase Farm Hospital
Edgware Hospital
Non Clinical
Obstetric
Oncology
Orthopaedic
Physio
Other
Paediatrics
Urology
4.6
RISK MANAGEMENT
Integrating Risk Management activity
This report contains incident management information from Datix, the
Trust’s new incident reporting system, which has been operational
since February 2004. Since Datix’s launch the Risk Team have noted
a steady rise in the number of reportable incidents and interpret this as
an indication of the growing confidence of staff in the reporting
mechanism. However, we need to encourage more staff to report
events and to deliver the message throughout the organisation that
people can report anonymously.
4.6.1 Incident Overview
A total of 1168 ‘events’ (incidents, near misses or hazards) were
recorded in the Trust during Q1 - April to June 2004. This is an
increase of 430 on the fourth quarter of last year. However, on analysis
of the data it appears that there has been a decrease in reporting from
the Women and Children’s Division by 23 events over the last quarter
while significant increases have been noted in Medicine (239) and
17
Surgery (109). There is also an upward trend in reporting for
Diagnostics & therapies (25) and Estates & Facilities (33).
The fall in the number of reports from the Women and Children’s
Division is probably due to the vacant Risk Facilitators post within the
Division. This is currently being addressed and the closing date for the
post is 26th August 2004.
4.6.2 Learning
The graph shows significant incidents in medicine and surgery. This is
primarily due to the number of slip, trips and falls reported and
medication errors reported.
4.6.3 Action
The Falls Strategy group is examining incidents and identifying
strategies to reduce the number of falls and will monitor effectiveness.
The medicine management group is examining incidents and
identifying strategies to reduce the number of medication errors in the
Trust.
4.6.4 Root Causes
The Risk Management Team are currently fully absorbing the new
model into our organisational culture of incident investigation and
prevention. As expected, the organisation still has a great deal to learn
from the process itself and how it can be used to optimal effect. The
IR2 form is used to allow staff to clearly define root causes of an event.
The Risk Management Team have designed Risk Management
Workshops for senior managers in the organisation, which include the
root cause analysis.
4.6.5 Actions
All senior managers within the organisation must attend the Risk
Management Workshop. Staff need to be trained in the Root Cause
Analysis model particularly if they are involved as lead investigators for
serious incidents. In addition Managers who are involved in
responding to Complaints will find root cause analysis helpful in their
investigation and development of action plans to address problems.
18
Near Miss
NonClinical
Incident
Hazard
Risk Events by Division and Type Q1 2004/5
700
Cumulative Frequency
600
500
400
300
200
100
0
Near Miss
Diagnostics
Therapies
and Cancer
Division
2
Estates and
Facilities
Directorate
Finance
Directorate
Human
Resources
Directorate
Medical and
Emergency
Division
Nursing
Directorate
Surgical and
Anaesthetics
Division
1
0
0
8
0
6
Women's
and
Children's
Division
3
NonClinical
0
0
0
0
0
0
1
0
Incident
70
55
0
1
645
2
275
87
Hazard
3
1
1
0
5
0
2
0
Division / Directorate
19
Reported Risks by CMG Q1 2004/5
Num ber
CMG / Specialty
0
Accident and Emergency
Anaesthetics
Breast Screening
Cancer
Cardiology
Childrens Services
Diabetes / Endocrinology
Gastroenterology
Head and Neck
Medicine for the Elderly
Med Neurology
Med Genito-Urinary
Med Dermatology
Med Haematology
Non Clinical
Orthopaedics
Outpatients Services
Pathology
Pharmacy
Radiology
Respiratory Medicine
Surgical Services
Therapies
Urology
Womens Services
50
100
150
200
250
300
350
400
450
500
113
19
1
1
25
27
3
5
8
435
1
1
1
Hazard
Incident
Non Clinical
10
Near Miss
103
76
19
10
13
16
33
128
9
21
57
20
5
Patient Implications
Ensuring that patients and their carers can get advice and help straight
away when they have a problem is demonstrated to improve patients’
experiences. Nationally patient’s experiences are measured through
the patient focus aspects of the balanced scorecard. Addressing those
areas that patients highlight as giving them cause for concern supports
the drive for improvement in results on Patients’ Surveys.
6
Service Implications
Taking and sharing the learning from Risk, PALS and Complaints will
ensure that service improvement is driven forward.
7
HR Implications
The learning from risk and the feedback from patients are used in staff
induction and in-service training. The number of enquiries to PALS
about jobs indicates that it may be useful to place vacancy bulletins in
public areas.
8
Financial Implications
Prompt action when problems occur can help reduce financial risks to
the organization.
9
Capital / Estates implications
The PEAT (Patient Environment Action Team) group follows up estates
issues arising from these reports.
10
Equalities Implications
The PALS and Complaints services can access the Trust Interpreter
Service as required. Enabling people to raise concerns informally,
either in person or by telephone demonstrates that it is a more
accessible route than formal letters of complaint. This is particularly
important for people who may be disadvantaged.
11
Risk Implications
Ensuring that patients, their families and friends can raise concerns
easily and informally ensures that potential risk issues can be
identified. We are looking at how the pro-active risk assessment tool
can be used to screen for unacceptable risks raised with PALS or
Complaints. Timely and effective intervention is an essential aspect of
managing risk to the organization.
21
12
NEXT STEPS
The Board will receive Quality and Governance Reports on a quarterly
basis.
13
CONCLUSION
In the last three months there has been significant progress in the
following areas:





Location of PALS services where they can be easily accessed
on both sites
Enhanced reporting through Datix
Integration of the PALS and Complaints services
Centralisation of the Risk team
Appointment of a substantive Head of Risk
The priorities now are to agree a revised integrated PALS and
Complaints Policy and operational procedures that clarify and simplify
what needs to be done when a concern or complaint is raised with a
member of Trust staff.
We also need to embed the new arrangements for responding to
Healthcare Commission Independent Review requests in order to meet
the two-week response time.
We need to continue to imbed risk into the Trust and to support this we
will be running workshops with the Divisions and the Directorates to
enable the generation of risk registers for these areas. The workshops
commence in September 2004 and aim to be completed by March
2005.
22
ANNEX 1
Directorate and Clinical Division PALS analysis
PALS Q1 2004/5 Analysis of Issues
Total contacts - 66
Subject
0
5
10
15
20
Att Amin
Att H Prof
Blood Tests
Contacting
Hyg Clean
MRSA
Other
rep OP
Pharmacy
PrivDignity
Results
Fares enq
HP treat
Med treat
Wait A&E
Wait Test
Xray
25
Diag Therapies &
Cancer
PALS Q1 2004/5 Analysis of Issues
Total Contacts 167
Subject
0
10
20
30
Att H Prof
Att Medic
Att Nurses
Blood Tests
Clled Oper
Clled Op
Contacting
Discharge
Environment
Falls
Hyg Clean
Acc Med
Other
OP apt post
rep OP post
Pharmacy
Property
Results
Transport
HP treat
Med treat
Mid treat
Understand
Wait A&E
Wait Apt
Wait Oper
Wait Test
Xray
40
50
Medical & Emergency
23
PALS Q1 2004/5 Analysis of Issues
Total contacts = 146
Subject
0
10
20
30
Att Amin
Att H Prof
Att Medic
Att Nurses
Clled Oper
Clled Op Rpt
Contacting
Discharge
Environment
Hyg Clean
MRSA
Other
OP apt post
rep OP post
Pain
Pharmacy
Pressure
PrivDignity
Property
Results
Transport
Fares enq
HP treat
Med treat
Mid treat
Understand
Wait A&E
Wait OP
Wait Oper
Wait Test
40
Surgical & Anaesthetics
PALS Q1 2004/5 Analysis of Issues
Total Contacts = 54
0
5
10
15
20
25
30
Att Medic
Att Midwives
Att Nurses
Breach Conf
Clled Oper
Subject
Clled Op Rpt
Contacting
Hyg Clean
Acc Med Rec
Other
OP apt post
rep OP post
Results
HP treat
Wait A&E
Women's & Children's
24
PALS Q1 2004/5 Analysis of Issues
Total contacts - 84
0
10
20
30
40
50
Att Amin
Blood Tests
Parking
Subject
Food
Contacting
Environment
Falls
Hyg Clean
Acc Med Rec
Other
Signage
Transport
Estates & Facilities
PALS Q1 2004/5 Analysis of Issues
Total contacts - 19
0
1
2
3
4
5
6
7
Accessibility
Subject
Parking
Other
Signage
Fares enq
Finance
25
PALS Q1 2004/5 Analysis of Issues
Total contacts - 35
0
10
20
30
40
Subject
Job enq
Other
Human Resources
PALS Q1 2004/5 Analysis of Issues
Total contacts = 5
0
1
2
3
Subject
Accessibility
Att H Prof
MRSA
Other
Nursing Directorate
26
ANNEX 2
PALS & Complaints
Coding - Subject
Car parking
Food and catering
Problem contacting department
Discharge Arrangements
Environment
Falls
Hygiene and Cleanliness
Patient did not have access to
Interpreter
Job enquiry
Access to medical records
Mixed sex wards
Concerns about MRSA
Outpatient appointment postponed
Outpatient appointment postponed
more than once
Other
Pain issues
Pharmacy issues
Pressure sores
Privacy and dignity
Lost or damaged property
Waiting for results
Signage or directions
Transport
Fares reimbursement query
Aspect of Health professionals
treatment
Aspect of Medical staff treatment
Aspect of nurses treatment
Patient could not understand staff
Length of wait in A & E
Length of wait in out-patient clinic
Length of wait for outpatient
appointment
Length of wait for operation
X-ray issues
Admission or discharge or transfer
arrangements
Aids and appliances or equipment
or premises
Delay or Cancellation for in-patient
appointments
Delay or cancellation for out-patient
appointments
Attitude of staff
All aspects of clinical treatment
Communication or Information
Complaints Handling
Consent to treatment
Discrimination
Independent sector services
commissioned by Health Authority
HA or PCT commissioning
Hotel services including food
Mortuary and post mortem
arrangements
Code of openness complaints
Others
Personal records
Policy and commercial decisions of
trusts
Patients privacy and dignity
Failure to follow agreed procedure
Patients property and expenses
Transport
Independent sector services
commissioned by Trust
PALS and Complaints
CODING Sub-subjects
Access to areas
Attitude of Admin staff
Attitude of Health Professionals
Attitude of Medical Staff
Attitude of Midwives
Attitude of Nurses
Blood Testing issues
Breach of Confidentiality
Cancelled operation
Cancelled operation more than
once
RISK Coding
NMISS
NINCID
INCID
HAZ
27
Near Miss
Not an incident
Incident
Hazard
Key to Claims Incident Types
Code
Incident Type
O755
0740
O660
O650
Foreign body left in situ
Lack of assistance/care
Surgical foreign body left in situ
Perineal tear- 1st degree, 2nd degree, 3rd
degree
Repeated attempts at forceps delivery
and/ventous
Failure to make timely response to
abnormalities in FHR
Failure to adequately monitor 1st stage of
labour
Failure to correctly interpret USS - follow up
or action
Failure of antenatal screening to detect
congenital abnormality
Repeated attempts at forceps delivery and/or
Ventouse
Self harm
Lack of adequate facilities / equipment
Failure to interpret x-ray correctly
Failure to x-ray
Medication errors
Failure to carry out adequate post-operative
observations
Failure of follow-up arrangements
Failure to warn/informed consent
Improper delegation to unsupervised junior
Performance of operation that is not
indicated
Intra-operative problems
Delay in performing an operation
Surgical foreign body left in situ
Failure/delay in referring to hospital
Failure/delay in admitting to hospital
Failure to recognize complication of
treatment
Wrong diagnosis made
Failure to diagnose/delay in diagnosis
Birth defects
Lack of preoperative evaluation
Inadequate monitoring intra-operatively
Inappropriate discharge
Bacterial infection
Fail/delay treatment
Other
O600
O550
O540
O520
O510
GO600
G240
G220
G190
G180
G170
G160
G140
G130
G120
G110
G090
G080
G070
G050
G040
G030
G020
G010
BD
A840
A820
999
998
790
680
28