Salisbury Foundation Trust


Internal Reference Number: FOI_5280

Date Request Received: 09/09/2019 15:10:48

Date Request Replied To: 07/10/2019 08:23:07

This response was sent via: By Email

Request Summary: "Exception Reports" by doctors

Request Category: Private Individuals

Question Number 1:
Does your Trust use “Exception Reports” that are used by doctors when day-to-day work varies significantly and/or regularly from the agreed work schedule?
Answer To Question 1:
Question Number 2:
If so, how many exception reports were logged as raising an immediate safety concern in the 2018/19 financial year?
Answer To Question 2:
Three were logged as an 'immediate safety concern', however we believe that one of these was flagged in error and subsequent investigation concluded it was not an immediate safety concern.
Question Number 3:
For each occurrence please state (a) when the incident took place, (b) which Trust site did it relate to and (c) provide a detailed, verbatim account of how the doctor described the concern as per the level of detail in the two examples below:

2 May 2017 – 0800 – “There are supposed to be a core number of 3 SHOs on the Rota, today there is only myself. The on-call full shift for neurosurgery (SHO) is under the empty slot on the Rota and has not been filled. The other SHO due to be in work today is now off post-nights as she was moved to nights last week last minute to cover another gap in the Rota. The Rota coordinator has put the shift out for locum. This gap in the Rota has been known about for at least 5 days. A datix is also being completed.”

This incident was immediately notified to the directorate manager who put in support with the registrar and ensured the consultant on call was aware of the situation. In addition on a daily basis have put in plans toreview medical staffing”

23 May 2017 – “Pulled from Breast Surgery day job at 11am and told I must come in and cover medical nights overnight for the rest of the week, despite being on Surgery. Told on the phone that the deputy medical director had talked to my consultant and said I must do this, as there would otherwise only be a single SHO looking after all of the medical patients in the hospital. After discussion with my consultant we reluctantly agreed that the best measure from a patient safety perspective would be for me to attend this shift, despite it being unsafe and bad for my personal training/development. Unfortunately, I did not manage much sleep before coming in for the night due to the short notice. Other than myself, there was only one doctor on ward cover nights (out of 3) and two SHOs and an F1 in MAU. Between myself and the other SHO on ward cover we were responsible for the care of 436 patients between the two of us, while carrying the crash bleep which covers the whole hospital (and incidentally kept us busy from around 04:00 - 07:00). We have Datix'd the unsafe environment and want it to be noted while having done our best; this was a very unsafe shift from the patient perspective.”
Answer To Question 3:
XXXXX, April 2018, SDH. Even before this day I had swapped a weekend so that my CT2 was not alone on the wards. There was no consultant ward round so another consultant did a trouble shoot round. Despite this we were still kept very late.

XXXXX, July 2018, SDH. Both SHOs on this shift felt strongly this night was an unmanageable work load for 2 SHOs with no senior support in the department (registrar or consultant) after 01.30. We had over a 4 hour wait for majors and 5 hours for minor injuries, multiple resus patients, and transfers both to ITU and SGH. Multiple patients with serious pathology such as chest pain were left without any review for over 4.5 hours due to workload on the SHOs. Consultant on call stayed later than scheduled but was also visibly exhausted and on discussion we felt we shouldn't call after they had left to escalate concerns as they would not be safe to return to work. Medical team very busy and unable to offer support due to their own workload. After discussion with GP ST1 and Medical Registrar on the night we decided that the night needs to be exception reported as it was clinically unsafe. Neither of the SHOs took any time for breaks as it was not possible to leave the patients we had with only one doctor.

We believe the following report was ticked as ‘an immediate safety concern’ in error. An investigation was conducted which concluded that it was not an immediate safety concern;

XXXX May 2018, extra time for two sick patients

We have removed any personal data that could directly or indirectly identify any individual. To provide this information would breach the fairness principle of data protection law. We believe this to be in line with data protection principles as set out in Section 40(2)(a) & (3A)(a) of the Freedom of Information Act 2000, relating to personal information.
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Our staff at Salisbury District Hospital have long been well regarded for the quality of care and treatment they provide for our patients and for their innovation, commitment and professionalism. This has been recognised in a wide range of achievements and it is reflected in our award of NHS Foundation Trust status. This is afforded to hospitals that provide the highest standards of care.

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