Coroner calls for ban on junior doctors working unsupervised at nightBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g222 (Published 14 January 2014) Cite this as: BMJ 2014;348:g222
A coroner has called for a ban on junior doctors working alone on night shifts, after a woman’s death at Basildon Hospital uncovered “woefully inadequate” care.
Lyn O’Reilly, 57, contracted a fatal infection after a bowel operation, and senior consultants missed the infection. Over the 2012 August bank holiday weekend she was put under the care of junior doctors who had been in the job for only four weeks. One junior doctor was caring for 130 patients alone during a night shift.
On 31 August 2012 O’Reilly, of Tilbury in Essex, was found collapsed in hospital toilets after days of complaining of pain, and she could not be saved. On 8 January 2014 an inquest into her death heard that “a window of opportunity was missed” to save her and that medical notes were “a shambles.”
Senior Essex coroner Caroline Beasley-Murray proposed a ban on junior doctors working unsupervised at night. Recording a narrative verdict, she said, “There were very serious failings in the postoperative care Mrs O’Reilly received at Basildon Hospital. The standard of documentation was woefully inadequate.”
The inquest heard that junior doctors had raised concerns but that consultants had not acted on them and that there was minimal senior support for junior staff during the day and at night. Poor communication between nurses and doctors was also given as a reason for the failure to deal with O’Reilly’s deterioration. In addition, poor notes meant that it was not clear whether a senior consultant had reviewed O’Reilly’s case on the morning of her death. It seemed that she had “probably not” been reviewed, the inquest heard.
A postmortem examination found abdominal fluid from an abscess that had burst and led to the fatal infection. Independent expert Jonathan Refson said that if he had seen O’Reilly on the morning of 30 August 2012 he would have arranged an urgent computed tomography scan.
“What this needed was someone with a bit of finesse coming in and saying, ‘This isn’t right,’” he said. “Acting first thing in the morning would have made a difference.”
Policies and procedures have been reviewed at Basildon Hospital, to change a culture that “overwhelmed” junior staff. More nursing staff now work over weekends and bank holidays, there is better support for junior staff, and an electronic program spots patient deterioration to help standardise practice and improve note taking.
The hospital’s medical director, Celia Skinner, said, “I am confident our competence is different compared with 2012, and our handover system is now robust.”
Cite this as: BMJ 2014;348:g222