Surge in number of severe 'adverse events' in Lothian A&Es

This included 17 deaths, 13 cases of "major harm", and 30 cases of "moderate harm".

Major harm is defined as incidents where lifesaving medical intervention was required or where the person has been left with a long-term disability.

Moderate harm means the individual has suffered "significant injury requiring medical treatment" but where the effects are expected to be short-term.

The total for the first 10 months of 2022 compares to 28 A&E-related Saers in the whole of 2020, and no more than 24 during 2021.

In 2020 and 2021 combined, there were 17 Saers initiated which related to a patient death in A&E - compared 17 in the first 10 months of 2022 alone.

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Saers are internal health board investigations which are carried out to establish what went wrong and whether it could have been avoided.

Not all Saers find fault with the patient's care, but the objective is to learn and improve safety.

Responding to the freedom of information request, NHS Lothian said it was unable to provide copies of the relevant Saer reports due to patient confidentiality and the time and and cost involved in redacting a "large amount" of information.

It comes amid spiralling pressures on emergency departments across Scotland, with a record 6,800 people spending over 12 hours in A&E departments during October due to shortages of available beds in hospital. 

On Thursday, NHS Lothian's chief executive Calum Campbell urged the public to stay away from the region's A&E departments unless they had a "critical emergency", describing the situation facing its acute hospitals as "undoubtedly the worst we have experienced so far".

Dr JP Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said: "We’re aware of increasing numbers of incident reports across the entire country, including Saers, from staff working in Emergency Departments.

"We know that dangerous crowding and staff shortages are widespread across Scotland. These incidents are a symptom and a marker of a system that’s long been in crisis.

"This needs urgent action to ensure we do not sink deeper into this risis and see the number of incidents and patients coming to harm increase.”

Dr Tracey Gillies, NHS Lothian's medical director, said patient safety is its "main priority", adding: "We actively encourage our staff to report any incident that may have had an adverse impact on patient care.

"We look at all Adverse Events that are recorded to ensure thorough and robust improvement and learning at all levels of the organisation.”

The freedom of information responses revealed significant regional disparities, however, with NHS Borders and NHS Forth Valley both saying they had carried out zero A&E-related Saers since 2020.

NHS Forth Valley was recently placed into special measures following concerns over leadership and safety, including recent criticism by inspectors that the emergency department (ED) at Forth Valley Royal was operating at 230 per cent capacity and that many of the patients treated in its ED and medical receiving units "did not appear well cared for".

NHS Ayrshire & Arran said it had carried out just one, while NHS Greater Glasgow and Clyde has yet to respond.

Several health boards - including Tayside, Fife, and Highland - provided the figures per year as "less than five" to protect patient confidentiality, so exact numbers  of Saers are unclear.

NHS Dumfries & Galloway said it had initiated seven A&E-related Saers in total since 2020, with NHS Grampian carrying out seven since April 2021 compared to just one in 2020/21.

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NHS Lanarkshire was the only health board to provide redacted copies of its Saer reports, which covered a total of eight A&E incidents - three in 2020/21, three in 2021/22, and two between April and November this year.

Of the seven reports completed to date, four identified issues which "may have caused or contributed to the event". Three of these incidents had occurred in 2022, and one in 2020.

One report from July 2022 detailed the case of an elderly patient who had suffered an inoperable brain haemorrhage after falling from a trolley and hitting their head while in the ED at Monklands hospital.

They died 11 days later.

Monklands Hospital in Airdrie (Image: PA)

The patient - described as having had "worsening mobility problems" and "cognitive decline" - had been brought to the hospital by ambulance after a relative found them on the floor at home.

For their "privacy and dignity", they had been left alone while passing urine - but a staff member subsequently found them lying on the floor outside their cubicle.

Investigators concluded that the fall "may have been avoidable" and recommended that, in future, patients with "cognitive impairment and/or falls risk should be offered supervision for toileting".

READ MORE: Medics plea over 'extremely busy and overcrowded' A&E 

Another report, from June 2022, detailed the case of a patient who had been referred by their GP with "intermittent" chest pain, breathlessness and an elevated heart rate. It is unclear which Lanarkshire emergency department was involved as this has been redacted.

The patient initially asked to remain in the waiting area before going on to suffer a fatal cardiac arrest around two hours later after being moved to a room in the Respiratory Assessment Area.

Investigators concluded that it was "appropriate" that the patient had been left in the waiting area because their chest pain was "not continuous".

They added that "mortality could not have been predicted when Patient A was triaged, [and] given their [medical] history this event was not survivable".

However, the report recommended that in future oxygen saturation measurements should be taken for eligible patients at triage to identify those at "high risk", and that the cardiac arrest trolley should be checked on a daily basis "to ensure the correct equipment is available".

The third case from August 2022 relates to a patient who suffered a life-threatening allergic reaction to antibiotics. The patient had been brought by ambulance to one of Lanarkshire's EDs with facial swelling caused by an infection linked to a dental abscess.

An investigation found that the patient had suffered a previous anaphylactic reaction to the same medication during a hospital admission in 2018, but they had not been informed about their allergy and there was "no robust process" in place to record it for future reference in the hospital notes.

As a result, the information was missing in the 'emergency care summary' available to the ED team.

The patient survived, but investigators concluded that the incident "was avoidable if the correct processes for recording anaphylactic shock had been followed".