• Northampton General Hospital Trust medical director says patient died “due entirely to the dangerous overcrowding of the department”
  • Hospital chief says death is due to stress on national emergency care system
  • Leaked message sets out actions trust is taking to cope with “extreme pressures”
  • Nene CCG asked to “share risk” and spot purchase care home beds

The death of a patient in an accident and emergency department was “due entirely to the dangerous overcrowding of the department”, the trust’s medical director has said.

An email to medical consultants at Northampton General Hospital Trust from medical director Matthew Metcalfe, leaked to HSJ, said the patient died on Wednesday night.

Northampton General Hospital

The trust’s A&E has seen high levels of demand for several months

Dr Metcalfe said: “Last night a patient died due entirely to the dangerous overcrowding of the department.

“The risk we have all been aware of, but may have felt hypothetical, has just happened.”

The man presented at the A&E with stomach pain and was initially seen and assessed within an hour. He was waiting on a chair to be seen by senior staff after a blood test suggested he may have heart problems. He deteriorated and suffered a cardiac arrest before being seen.

Trust chief executive Sonia Swart told HSJ today that staff at the trust were working hard under extreme pressure.

She said: “This is a national issue. This is increasingly obvious from all the reports that are coming out this winter. This winter has clarified more than anything else that this is a national issue. We are not trying to say there is nothing we can do about it. We are saying we can do better and we will do.”

Dr Metcalfe’s message was sent yesterday in a bid to encourage all senior staff to help the trust cope with “extreme” pressure. Yesterday the trust said it had been on the highest level of alert for the three days.

The email revealed consultants were being allocated to wards to review all inpatients.

It added: “We need to do more to distribute patient risk through the trust and through the system. The part we are asking you to play is in providing the senior medical review making sure that there are no patients kept in hospital for medical reasons unless essential. I acknowledge that may have an impact on outpatients, etc, carrying a risk of its own. I know you will work with your clinical leads to minimise this.”

Among the actions he said the trust was taking was increasing the use of “rapid transfer”, where patients are moved to a ward ahead of a patient being discharged. He said: “This is essentially a clinically safe version of the practice of ‘boarding’ patients.”

Patients who can be transferred safely to nursing homes were being identified and Nene Clinical Commissioning Group was being asked to “spot purchase” beds for them. Dr Metcalfe said: “It is important that the CCG shares the risks to our patients.”

The trust’s response

A trust statement said every effort was made to see, assess and treat patients quickly. But it said “in this situation the long wait for further treatment and assessment led to an unacceptable outcome.

“Over the past several months our emergency department has seen high levels of demand, with an average of 400 patients a day attending, an increase of almost 30 per cent on the same period last year. This has inevitably had an impact on our ability to consistently provide a high standard of patient safety in our ED.”

The trust said the patient arrived after 4pm “with non-specific upper abdominal pain”. He was triaged at 5.30pm and had an electrocardiogram and blood tests. The results of the blood tests revealed the patient was anaemic with a possible cardiac problem and the plan was to transfuse him.

Its statement said: “Just before 1am on 8 March the gentleman’s condition was seen to have deteriorated and he was transferred from the waiting area to majors where he suffered a cardiac arrest. Despite the best efforts of our staff in the emergency department they were unable to resuscitate him.

“Ideally this patient would not have waited so long, would have been reviewed sooner by a senior consultant and might have been in a hospital bed on a ward at the time of his deterioration. We don’t yet know what difference this would have made to the final outcome.

“We have expressed our sincere apologies to the family and will work with them to undertake an investigation so that we can fully understand the circumstances that led to their loved one’s death. The findings will be shared with them as it is important to us that we help relatives understand the reasons for a loved one’s death. Equally it is important for us to acknowledge where we could have done more and to ensure any learning from this sad incident is taken forward.”

A Department of health and Social Care spokesman said: “Patient safety must not be compromised in this way - we expect hospitals to plan around busy periods to ensure patients continue to get safe care.“This is a tragic situation and we will be supporting NHS Improvement as they work closely with the Trust to fully understand the circumstances, which will be done through a full investigation.”