PFD report

Jordan Michael BABB · Prevention of Future Deaths report

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Issued 25 Jul 2025•Milton Keynes

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

View original report
Concerns
5

Raised in this report

Recipients
1

Named on the report

Responses found
1

Of 1 recipient

Stated actions
9

Described in responses

Source document

Full report text

This is the full text from the original published report.

Open published report

Concerns and recipient responses

Select any concern, action or position to view the source wording.

Report evidence summary

Concerns raised5

  1. Lack of formal thresholds or protocols for urgent escalation of abnormal observations
    Part of recurring concern: Failure to escalate significant clinical concerns to appropriately senior cliniciansPart of recurring concern: Unreliable escalation of abnormal clinical observations
  2. Lack of a specific protocol or decision-support mechanism for recognition and escalation of life-threatening conditions
  3. Failure to apply an evidence-based pulmonary embolism diagnostic pathway
    Part of recurring concern: Unreliable recognition and management of pulmonary embolism
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.7

  1. Action

    Deliver clinician information sharing and case-based training on Wells PE, Ardens templates, clinical context and NICE-aligned use of decision tools.

    Stated by Milton Keynes Urgent Care Services (MKUCSStated completedThe respondent said that this action was complete when they made their response on 28 July 2025.
  2. Action

    Provide Ardens templates integrated with SystmOne to support structured Wells pulmonary embolism assessment, risk stratification and escalation.

    Stated by Milton Keynes Urgent Care Services (MKUCSStated completedThe respondent said that this action was complete when they made their response on 28 July 2025.
  3. Action

    Audit and provide feedback on clinicians’ application of Wells PE and related clinical decision tools.

    Stated by Milton Keynes Urgent Care Services (MKUCSStated completedThe respondent said that this action was complete when they made their response on 28 July 2025.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.3

  1. Position

    PERC is considered inappropriate for primary care because it is not validated in that setting; Wells scoring is preferred for suspected pulmonary embolism.

    Stated by Milton Keynes Urgent Care Services (MKUCSDisputes the concernThe respondent disagreed with part of the concern or the basis for it.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Lack of formal thresholds or protocols for urgent escalation of abnormal observations

Wider context from the report

“1. Failure to Escalate Abnormal Observations Despite the patient presenting with a significantly elevated heart rate, high respiratory rate, and reduced oxygen saturations — all indicative of physiological instability — there was no escalation to secondary care or referral to the emergency department. There appears to have been no formal threshold or protocol in place to ensure that abnormal observations of this nature trigger an urgent clinical response. ”

Is this part of a recurring concern?

Yes — Failure to escalate significant clinical concerns to appropriately senior clinicians; Unreliable escalation of abnormal clinical observations.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Lack of a specific protocol or decision-support mechanism for recognition and escalation of life-threatening conditions

Wider context from the report

“4. Risk of Repetition in Similar Settings The inquest heard no evidence that the walk-in centre has a specific protocol or decision-support mechanism in place for the recognition and escalation of potentially life-threatening conditions such as pulmonary embolism. There is a risk that similar failings could occur in future, particularly where patients present with non-specific symptoms and abnormal vital signs. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to apply an evidence-based pulmonary embolism diagnostic pathway

Wider context from the report

“2. Lack of Structured Risk Assessment for Pulmonary Embolism Although pulmonary embolism was a relevant clinical possibility, no structured risk assessment tool (such as the Wells score) was used or documented, and there was no attempt to apply an evidence-based diagnostic pathway as recommended by NICE guidance (NG158). ”

Is this part of a recurring concern?

Yes — Unreliable recognition and management of pulmonary embolism.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Lack of clarity or training on the scope and limitations of clinical decision tools

Wider context from the report

“3. Unclear Use or Misunderstanding of Clinical Decision Tools Evidence suggested uncertainty about the appropriate use of the Pulmonary Embolism Rule-out Criteria (PERC) in primary care settings, with potential misapplication outside of the specific context recommended by NICE (i.e., in low-risk patients only and following validated pre-test probability assessment). There appears to be a lack of clarity or training regarding the scope and limitations of such tools in the primary care context. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to use or document structured pulmonary embolism risk assessments

Wider context from the report

“2. Lack of Structured Risk Assessment for Pulmonary Embolism Although pulmonary embolism was a relevant clinical possibility, no structured risk assessment tool (such as the Wells score) was used or documented, and there was no attempt to apply an evidence-based diagnostic pathway as recommended by NICE guidance (NG158). ”

Is this part of a recurring concern?

Yes — Unreliable recognition and management of pulmonary embolism.

Open source report

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Deliver clinician information sharing and case-based training on Wells PE, Ardens templates, clinical context and NICE-aligned use of decision tools.

Verbatim wording from the response

“Clinician Training and Ongoing Learning”

Source location

Milton Keynes Urgent Care Services
Page 4 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Provide Ardens templates integrated with SystmOne to support structured Wells pulmonary embolism assessment, risk stratification and escalation.

Verbatim wording from the response

“MKUTC supports safe and consistent application of evidence-based clinical decision tools through Ardens templates integrated within SystmOne. These digital templates provide clinicians with immediate access to structured assessment pathways and risk stratification tools during consultations.”

Source location

Milton Keynes Urgent Care Services
Page 3 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Audit and provide feedback on clinicians’ application of Wells PE and related clinical decision tools.

Verbatim wording from the response

“• Audit and feedback mechanisms to ensure safe, consistent application across the clinical team.”

Source location

Milton Keynes Urgent Care Services
Page 4 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Operate standardised NEWS2 and POPS assessment within 15 minutes, with senior triage review and immediate escalation to the Emergency Department when indicated.

Verbatim wording from the response

“Robust systems currently in operation. All patients presenting at MKUTC undergo a standardised early warning assessment within 15 minutes of arrival:”

Source location

Milton Keynes Urgent Care Services
Page 2 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Introduce clinicians to PERC, train them on its limitations, and reinforce that high-risk patients are escalated to the Emergency Department.

Verbatim wording from the response

“Awareness of PERC (Pulmonary Embolism Rule-out Criteria)”

Source location

Milton Keynes Urgent Care Services
Page 5 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Conduct regular audits of NEWS2, POPS, risk assessments and decision tools, with monthly KPI reporting and quarterly commissioner review.

Verbatim wording from the response

“• Regular audits are conducted on the use of NEWS2, POPS, risk assessments, and decision tools.”

Source location

Milton Keynes Urgent Care Services
Page 6 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Review clinical incidents through governance structures and embed learning into staff training and updated protocols.

Verbatim wording from the response

“Clinical incidents are reviewed through established governance structures, with learning embedded into training and updated protocols.”

Source location

Milton Keynes Urgent Care Services
Page 6 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

PERC is considered inappropriate for primary care because it is not validated in that setting; Wells scoring is preferred for suspected pulmonary embolism.

Verbatim wording from the response

“All MKUCT clinicians have been introduced to the Pulmonary Embolism Rule-out Criteria (PERC). While PERC can be valuable in secondary care settings, its application in primary care is more limited due to differences in patient population, availability of confirmatory investigations, and clinical context.”

Source location

Milton Keynes Urgent Care Services
Page 5 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Ardens templates in SystmOne and Wells PE risk assessment are considered sufficient to provide structured pulmonary embolism assessment and escalation.

Verbatim wording from the response

“2. Lack of Structured Risk Assessment for Pulmonary Embolism”

Source location

Milton Keynes Urgent Care Services
Page 3 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Standardised NEWS2/POPS assessment, senior triage review and established escalation pathways are considered sufficient to address abnormal observations.

Verbatim wording from the response

“1. Failure to Escalate Abnormal Observations”

Source location

Milton Keynes Urgent Care Services
Page 2 · response
Published 28 July 2025

Open published response

Other statements in published responses

These actions and other statements could not be clearly connected to one concern in this report.

Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.2

  1. 1

    Audit and review individual clinician performance through personal development meetings.

    Stated by Milton Keynes Urgent Care Services (MKUCSStated completedThe respondent said that this action was complete when they made their response on 28 July 2025.
  2. 2

    Consult regional GP clinical leads through the ICB to evaluate PERC’s appropriateness and share related learning and awareness.

    Stated by Milton Keynes Urgent Care Services (MKUCSStated completedThe respondent said that this action was complete when they made their response on 28 July 2025.

Recipient positions A position is what a recipient says about a concern when they do not describe a specific action.1

  1. 1

    Established incident review, audit, governance meetings and commissioner reporting are considered sufficient to embed learning and reduce repetition of similar incidents.

    Stated by Milton Keynes Urgent Care Services (MKUCSExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Audit and review individual clinician performance through personal development meetings.

Verbatim wording from the response

“• Individual clinician performance is audited and reviewed in personal development meetings.”

Source location

Milton Keynes Urgent Care Services
Page 6 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Consult regional GP clinical leads through the ICB to evaluate PERC’s appropriateness and share related learning and awareness.

Verbatim wording from the response

“As part of this objective, MKUCS have involved the BLMK ICB to share learning, understanding and awareness across the region. All BLMK GP Clinical leads were consulted with via the ICB to evaluate the appropriateness of this tool. The consensus is that the PERC tool is not appropriate for primary care settings.”

Source location

Milton Keynes Urgent Care Services
Page 5 · response
Published 28 July 2025

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Established incident review, audit, governance meetings and commissioner reporting are considered sufficient to embed learning and reduce repetition of similar incidents.

Verbatim wording from the response

“4. Risk of Repetition in Similar Settings”

Source location

Milton Keynes Urgent Care Services
Page 6 · response
Published 28 July 2025

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Official responses located
1/1

Data last updated 7 September 2026