There were 'gross failings' at King's Mill Hospital in Sutton-in-Ashfield
A coroner has released a report detailing a number of concerns regarding the care provided by a Nottinghamshire hospital. Ten-week-old Tommy Gillman died on December 8, 2022, from sepsis and multi-organ failure following an infection with Salmonella Brandenburg meningitis.
He was provided with prompt treatment for septic shock and meningitis, which he did not respond to, and following a transfer to Leicester Royal Infirmary, died the next day. Coroner Didcock has raised three matters of concern following the inquest carried out into Tommy's death, which concluded on March 15 at Nottingham Council House.She asked for action to be taken to prevent future deaths.
Coroner Didcock's second concern detailed how handovers and key conversations between members of staff are not routinely documented, while escalations do not result in clear action plans and allocated tasks. Finally, the system for recognising an illThis includes the point of attendance, timely triage, timely escalation, and joint assessment by senior Emergency Department and paediatric staff.
"The comprehensive findings of both the Coroner’s review and our own internal investigations have helped us to put in place a rapid programme of improvements that we have made good progress on implementing to ensure we can continue to provide the best possible care in future." The trust added that it has identified a number of key actions as part of the Trust's "rapid" improvement programme.
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