Recurring concern
Unsafe management of significant bleeding
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Request correctionFirst reported 20 Feb 2015•Latest report 13 Dec 2024
What this concern includes
Includes failures of controls specifically dedicated to preventing, recognising, assessing, escalating, investigating or treating significant bleeding, including bleeding associated with medicines, procedures or defined clinical hazards.
Not included
- Excludes generic staff training, documentation, communication or staffing deficiencies not explicitly tied to significant bleeding management.
- Excludes unrelated medication, diagnostic, procedural or deterioration concerns where bleeding is not the specific hazard being controlled.
- Excludes the mere absence or use of clinical guidance when the guidance is not specifically concerned with significant bleeding.
- Reports
- 8
- Individual concerns
- 10
- Date range
- 2015–2024
- Stated actions
- 17
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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Concerns raised2
Omission of covert bleeding from the Trust Drills & Skills Booklet
Failure to consider bleeding as a cause of maternal deterioration
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
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Action
Embed deterioration recognition, concealed-bleeding assessment and escalation training in PROMPT, induction, local teaching, drills and written staff communications.
Stated by Mid and South Essex NHS Foundation Trust -
Action
Provide guidance on preventing and managing postpartum haemorrhage, including clinical assessment, monitoring, escalation and multidisciplinary response.
Stated by Royal College of Obstetricians and Gynaecologists -
Action
Provide guidance on maternal collapse, including early-warning observation, systematic cause identification, ongoing assessment and concealed-haemorrhage diagnosis.
Stated by Royal College of Obstetricians and Gynaecologists
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Action
Implement the OBS UK obstetric bleeding care bundle covering risk assessment, quantitative blood-loss measurement, escalation, and rapid clotting tests.
Stated by Mid and South Essex NHS Foundation Trust -
Action
Implement the national MEWS observation package and escalation policy, including trigger-team referral and mandatory maternity-inpatient use.
Stated by Mid and South Essex NHS Foundation Trust
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Concerns raised1
Failure to treat bleeding in pregnancy as potentially serious until proven otherwise
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
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Action
Update, ratify and disseminate the Antepartum Haemorrhage guideline, including immediate assessment, worst-case assumptions, telephone triage, escalation, and documentation requirements.
Stated by Sherwood Forest Hospitals NHS Foundation Trust -
Action
Disseminate the RED React, Escalate, Diligent prompt cards and associated guidance on managing and escalating bleeding.
Stated by Sherwood Forest Hospitals NHS Foundation Trust -
Action
Provide individualised support and training to staff who do not understand the amended guideline.
Stated by Sherwood Forest Hospitals NHS Foundation Trust
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Action
Continue multidisciplinary review of Antepartum Haemorrhage cases through the weekly Triggers meeting, escalating incidents and learning when required.
Stated by Sherwood Forest Hospitals NHS Foundation Trust
-
Concerns raised1
Upper GI Bleeding Management and Principles of Care guidance no longer fit for purpose
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Update the Upper GI Bleeding Management and Principles of Care guideline to align with NICE and British Society of Gastroenterology guidance.
Stated by Betsi Cadwaladr University LHB
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
The upper gastrointestinal bleeding guideline was updated, follows NICE and British Society of Gastroenterology guidance, and is scheduled for review.
Stated by Betsi Cadwaladr University LHB
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Concerns raised1
Failure of MPDS to account for the duration of persistent bleeding
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Implement new language defining SERIOUS Haemorrhage and structuring its Key Question to identify persistent, uncontrolled bleeding more definitively.
Stated by International Academies of Emergency Dispatch
-
Concerns raised1
NICE guidelines inadequately addressing slow intracranial bleeding after falls in elderly patients
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
-
Action
Conduct the ongoing surveillance review of the head injury guideline to determine whether it requires updating.
Stated by National Institute for Health and Care Excellence -
Action
Publish the final surveillance review decision in September 2019.
Stated by National Institute for Health and Care Excellence
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
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Position
NICE guidelines do not apply to the organisation, so it will not undertake work to address their adequacy.
Stated by Shaw Healthcare Limited
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Position
The Chief Executive of NICE is responsible for responding to concerns about the adequacy of NICE guidelines.
Stated by Shaw Healthcare Limited -
Position
Existing NICE head-injury guidance already applies to injuries caused by both direct and indirect trauma.
Stated by National Institute for Health and Care Excellence
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Concerns raised1
Lack of literature informing anticoagulant therapy patients about the steps to take in response to a brain bleed
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
-
Concerns raised2
Lack of staff knowledge, application and implementation of guidelines for managing bleeding associated with thrombolytic therapy
Lack of staff knowledge, application and implementation of protocols for managing massive blood loss
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Action
Circulate and maintain the new thrombolysis policy on the Trust intranet.
Stated by Pennine Acute Hospitals NHS Trust -
Action
Deliver thrombolysis and bleeding-risk training to Critical Care staff.
Stated by Pennine Acute Hospitals NHS Trust -
Action
Deliver mandatory training on thrombolysis policies and associated bleeding risks to medical staff.
Stated by Pennine Acute Hospitals NHS Trust
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Concerns raised1
Lack of defined assessment and management steps for variceal bleeding
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
-
Action
Share Leeds emergency variceal-management guidelines with referring trusts.
Stated by Leeds Teaching Hospitals NHS Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
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Position
The concerns cannot be pursued personally because involvement would create an obvious competing interest in the index case.
Stated by Cardiff & Vale University LHB
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Position
The concerns should be directed to the BSPGHAN President, because they concern complex liver disease and portal hypertension beyond endoscopic banding alone.
Stated by Cardiff & Vale University LHB -
Position
Organisations such as RCPCH, JAG, NICE or the NHS are better placed to advance and compel the requested national change.
Stated by Cardiff & Vale University LHB -
Position
Current guidelines are considered sufficient for post-operative care and management of bleeding varices, including after prophylactic banding.
Stated by Leeds Teaching Hospitals NHS Trust
Data last updated 7 September 2026