A&E bed blocking factor in woman's death - coroner

A coroner has warned there is "clearly a risk" of others dying after delays discharging hospital patients contributed to a woman's death.

Barbara Wingate, 71, was admitted to Medway Maritime Hospital after a fall in May but was not taken to A&E's resuscitation department as no beds were available. She died three days later.

Kent and Medway coroner Catherine Wood concluded Wingate died of fall injuries "contributed to by avoidable delays in diagnosing and treating her pelvic fractures".

Medway NHS Foundation Trust said it was "deeply sorry for the circumstances of her death" and fully accepted the coroner's findings.

According to the coroner, Wingate arrived by ambulance at the Gillingham hospital's accident and emergency just before midnight on 18 May and was taken to the rapid assessment unit.

"She should have gone to the resuscitation department" and a "full trauma call" should have been initiated, but it was full, the coroner said.

Wood wrote in a prevention of future deaths report that evidence indicated this was "almost a daily occurrence" at the hospital.

Wingate, who had a history of heart problems, did not initially receive a pelvic x-ray that would have revealed multiple fractures until after she "collapsed" at about 16:00 BST the next day.

This was despite being in "significant pain" and the scan being suggested at 08:30, according to the report.

Wingate suffered a cardiac arrest but was stabilised and transferred to Kings College Hospital, and later moved into intensive care, where she died.

Interim chief executive Jonathan Wade said the trust recognised "the impact that delays in assessment, imaging and patient flow" had on her treatment.

Since this incident the trust had "strengthened trauma pathways" and "increased senior clinical oversight in the emergency department", he said.

The Department for Health and Social Care, Kent and Medway Integrated Care Board (ICB), Medway Council and Kent County Council, must respond to the report by 8 April.

According to the document, the "main issue" was difficulty moving patients from A&E to other wards to free up resuscitation bays.

On any given day "up to a third of the hospital beds can be filled with patients who are fit to leave hospital", the coroner said.

The inquest heard the trust had "taken all steps they can internally" to improve patient flow but the main difficulty was discharging patients into social care, according to Wood.

The coroner said evidence suggested that where patients were "self-funding" social care, delays were "less acute".

The hospital said it was working "closely with NHS and social care partners to improve the timely discharge of medically fit patients, which remains a significant system wide challenge".

The ICB said it took the findings "very seriously" and was was working with partners "to support people to return home sooner, with the right help in place".

"While the majority of patients leave our hospitals when they are well enough to go home, we know more needs to be done to prevent the delays that some experience," a spokesperson said.

The Department of Health and Social Care said its "deepest sympathies" were with Wingate's family and it would "consider this report in full before formally responding".

Kent County Council said it was "working with NHS partners to strengthen the discharge process and support people leaving hospital into the most appropriate settings".

Medway Council said it was working "to strengthen the discharge process" and it encouraged anyone who may require care "to contact us directly".

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