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FOI 3889 A list of all serious untoward incidents in the calendar year 2015 [to date].

I would like to request the following information – A list of all serious untoward incidents in the calendar year 2015 so far, for each hospital site you cover.

As part of Trust Board Papers (Safety SitRep section in the Integrated Quality and Performance Report), the Trust publishes a list of all SUI’s (Serious Untoward Incidents) that have been investigated through a Trust level investigation process. This list provides a high level summary of the incident and once the investigation has been completed, includes a summary of the recommendations.

Please note: This list does not include all incidents which are reported to our Commissioners under the National Serious Incident Framework.

The Trust board papers are available at this site

As the information is already, or will be once available, published elsewhere, exemptions under sections 21 and 22 of the FOIA are applicable, however for your ease we have also provided a very high level list.


Date of Incident Location of Incident Brief Description Investigation Outcome / Key Themes
12/03/15 Solihull Hospital Missed pneumothorax diagnosis Misinterpretation of chest x-ray, communication
13/02/15 Heartlands Hospital Sub-optimal care of deteriorating patient Lack of monitoring of blood tests, delay in transfer to critical care
11/02/15 Good Hope Hospital Wrong body released Investigation on-going
03/06/15 Heartlands Hospital Unexpected neonatal death Currently under investigation
18/04/15 Heartlands Hospital Unexpected intrapartum death Currently under investigation
21/02/15 Heartlands Hospital Unexpected death Communication, documentation, direct patient observation
14/04/15 Good Hope Hospital Recognition of deteriorating patient Currently under investigation




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