St George’s patient record keeping at “extreme” risk

A London trust’s board papers has revealed its record keeping is at “extreme” current risk, according to its risk register.

St George’s University Hospitals NHS Foundation Trust is checking hundreds of thousands of records to see if patients did not receive treatment because of poor data systems.

The issue comes to light after a Freedom of Information request revealed that two patients came to “severe harm” – where one patient suffered a stroke that might have been prevented and another received late treatment for cancer due to record keeping issues.

A separate risk entry in the trust’s May board papers under “fragmented electronic and manual patient records” is stated as being “extreme” with potential “catastrophic” consequences.

According to HSJ who obtained the FOI, the department in haematology was busy and the patient who suffered a stroke was not entered on the booking system, nor were they flagged as having a blood disorder.

The report said “the delay in diagnosing the haematological disorder may have contributed to them having a stroke”.

In the second incident the patient missed out on urgent cancer surgery because their appointment was not booked after a referral.

In a statement provided to Digital Health News, the trust said: “We take issues of patient safety extremely seriously, and fully investigate cases where there is evidence that care may have been compromised. In both cases, we informed the patients in question, told them we were investigating, and stressed our determination to learn lessons wherever errors have been made.”

The trust continued to explain that “this is standard practice as part of our SI process, and key to maintaining an open and transparent culture of incident reporting at St George’s. Our elective care recovery programme is designed to improve how we record where patients are on their elective care pathway, and reduce their waiting times.”

“This is a major priority for the Trust, and key to ensuring we provide safe and effective care for our patients.”

It is understood that 2 million electronic records of patient pathways were found to be incomplete at St George’s. Of these, 124,000 were subsequently classified as “potentially high risk”.

In March this year the trust was being investigated by an external clinical review group after patients missed urgent referrals due to lack of record keeping.

The trust stopped reporting RTT figures in July last year, citing unreliable data, and has since embarked on major recovery programme.

A subsequent review revealed a range of IT problems, including “inadequately supported” software, such as XP, ageing computers, and insufficient data storage capacity.

In November, a Care Quality Commission report rated the trust as “inadequate” overall, noting its poor data quality and non-reporting of RTTs among other broader problems. The trust was subsequently placed into special measures.

Digital Health News reported in February that the trust said its clinical data is “fundamentally broken” in its January board papers.

“These reviews highlighted multiple operational process and technology issues that pointed to patients receiving a sub-standard level of care and potential clinical risk,” the report said.

The “poor quality” of data on referral to treatment (RTT), including cancer and diagnostic pathways “were viewed as fundamentally broken”, the report said.

Another trust facing issues with record keeping include Sheffield Teaching Hospitals NHS Trust, whose April board papers reveal that nearly 15,000 patient records were affected by a technical mishap in the trust’s Lorenzo patient administration system.

The issue was that patient letters were being generated, but then failing to be printed.  The failure resulted in some patients not receiving letters referring them for further appointments.

Digital Health News has contacted St George’s University Hospitals NHS Foundation Trust for comment.

Additional reporting by Laura Stevens.