Geoffrey Robin Brooks · Prevention of Future Deaths report

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Issued 15 Sep 2023•Exeter and Greater Devon

Published report and response evidence

This report’s concerns and statements found in recipients’ published responses. Statements are included even where no link to an individual concern is recorded. A link shows an evidence connection; it does not assign responsibility.

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Concerns
1

Raised in this report

Recipients
1

Named on the report

Responses found
1

Of 1 recipient

Stated actions
11

Described in responses

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

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

Report evidence summary

Concerns raised1

  1. Failure of discharge summaries to clearly communicate target fluid intake
    Part of recurring concern: Unreliable communication of patients' nutritional requirementsPart of recurring concern: Unreliable hospital discharge processes

Stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.11

  1. Royal Devon University Healthcare NHS Foundation Trust

    Review use of the After Visit Summary across inpatient and outpatient services through an established working group.

  2. Royal Devon University Healthcare NHS Foundation Trust

    Use bespoke discharge-summary templates for complex patient groups to clarify pertinent information and follow-up instructions.

  3. Royal Devon University Healthcare NHS Foundation Trust

    Review community-hospital staffing to develop a more robust, consistent medical team with specialty-doctor and Advanced Clinical Practitioner oversight.

  4. Royal Devon University Healthcare NHS Foundation Trust

    Maintain a four-day junior-doctor rota in Medicine to reduce cross-cover and improve staffing consistency for discharge documentation.

  5. Royal Devon University Healthcare NHS Foundation Trust

    Disseminate future discharge-related learning through relevant forums, teaching sessions and training packages.

  6. Royal Devon University Healthcare NHS Foundation Trust

    Transition to the Patient Safety Incident Response Framework and focus future investigations on hospital discharge.

  7. Royal Devon University Healthcare NHS Foundation Trust

    Relaunch the Trust-wide discharge-summary working group with primary-care representation to refine discharge processes and communication.

  8. Royal Devon University Healthcare NHS Foundation Trust

    Provide junior doctors with Epic discharge-process training through Trust and departmental induction.

  9. Royal Devon University Healthcare NHS Foundation Trust

    Improve discharge-summary completion rates and ensure summaries are sent within 24 hours of relevant attendance.

  10. Royal Devon University Healthcare NHS Foundation Trust

    Use Epic’s Hospital Course function to build discharge summaries from clinicians’ real-time inpatient documentation.

  11. Royal Devon University Healthcare NHS Foundation Trust

    Produce guidance and standard operating procedures for ward teams following the After Visit Summary review.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.1

  1. Royal Devon University Healthcare NHS Foundation Trust

    The Trust considers reviewing every discharge letter by a consultant infeasible because of resource demands, unclear responsibility, delays and risks of error.

    Unable to actThe respondent said that a constraint prevented them from taking the relevant action.

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 of discharge summaries to clearly communicate target fluid intake

Wider context from the report

“During his evidence the consultant physician with the responsibility for the care and treatment of Mr Brooks acknowledged that the discharge summary was ambiguous and did not make it clear that the 2.5 – 3L was a target fluid intake; he agreed that it could be interpreted that Mr Brooks should be restricted to no more than 2.5 to 3L of fluid a day. As a consequence, the nursing home staff were unaware of the needs of Mr Brooks. The target fluid intake was not met in the period that Mr Brooks was in the nursing home, which contributed to his death. ”

Is this part of a recurring concern?

Yes — Unreliable communication of patients' nutritional requirements; Unreliable hospital discharge processes.

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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 use of the After Visit Summary across inpatient and outpatient services through an established working group.

Verbatim wording from the response

“3. After Visit Summary Epic has introduced the ability to generate a patient focused document for inpatient and outpatient attendances - the After Visit Summary (AVS) which can be given to patients at the point of hospital discharge. To date, the AVS has not been widely rolled out, particularly after inpatient stays.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 2 · response
Published 26 September 2023

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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

Use bespoke discharge-summary templates for complex patient groups to clarify pertinent information and follow-up instructions.

Verbatim wording from the response

“2. Bespoke templated discharge summaries Some areas (e.g. Stroke, Acute Care of the Elderly) have specific templates for completing discharge letters which ensures pertinent information and ongoing instructions are as clear as possible. This is important for more complex patient groups who need to have specific assessments and follow-up.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 2 · response
Published 26 September 2023

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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 community-hospital staffing to develop a more robust, consistent medical team with specialty-doctor and Advanced Clinical Practitioner oversight.

Verbatim wording from the response

“We are currently reviewing the staffing model of our community hospitals which we hope will lead to a more robust, consistent medical team with specialty doctor and Advanced Clinical Practitioner oversight. This will provide an additional safety-net around discharge and again letters will be more likely to be written and checked by individuals who have reliably been involved in a patient’s care.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 3 · response
Published 26 September 2023

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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

Maintain a four-day junior-doctor rota in Medicine to reduce cross-cover and improve staffing consistency for discharge documentation.

Verbatim wording from the response

“5. Enhanced ward staffing consistency Within Medicine, our staffing model was changed recently so that junior doctors in training have switched to a 4-day working week. Previously, compensatory rest meant that juniors were often moved from their base wards to cover rota gaps; this led to a loss of consistency in medical staffing which is a risk to discharge letters writing as discussed above. The new rota pattern means the need for cross cover is greatly reduced.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 2 · response
Published 26 September 2023

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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

Disseminate future discharge-related learning through relevant forums, teaching sessions and training packages.

Verbatim wording from the response

“The Trust is currently transitioning to the Patient Safety Incident Response Framework which will guide future investigations into patient safety incidents. This process involved detailed retrospective analysis of 117,000 events which were thematically reviewed to identify key areas for future investigations. One of the three main themes was discharge from hospital; this will be a focus for future investigations due to the significant potential for systemic learning and improvement. Future learning will help guide further refinement of our discharge processes. Learning will be disseminated through relevant forums, teaching sessions and training packages.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 3 · response
Published 26 September 2023

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

Transition to the Patient Safety Incident Response Framework and focus future investigations on hospital discharge.

Verbatim wording from the response

“The Trust is currently transitioning to the Patient Safety Incident Response Framework which will guide future investigations into patient safety incidents. This process involved detailed retrospective analysis of 117,000 events which were thematically reviewed to identify key areas for future investigations. One of the three main themes was discharge from hospital; this will be a focus for future investigations due to the significant potential for systemic learning and improvement. Future learning will help guide further refinement of our discharge processes. Learning will be disseminated through relevant forums, teaching sessions and training packages.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 3 · response
Published 26 September 2023

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

Relaunch the Trust-wide discharge-summary working group with primary-care representation to refine discharge processes and communication.

Verbatim wording from the response

“The Trust wide discharge summary working group will be shortly relaunched with a plan to have primary care representation to try and further refine discharge processes and communication with primary care. There is potential to develop more discharge summary templates for specific specialties or conditions. We are continually working on improving the completion rates of discharge summaries and ensuring they are sent in accordance with the NHS Standard Contract agreement of within 24 hours following inpatient, day case or ED attendance.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 3 · response
Published 26 September 2023

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 junior doctors with Epic discharge-process training through Trust and departmental induction.

Verbatim wording from the response

“4. Education around discharge Junior doctors receive induction and complete training in Epic which includes the discharge process and completion of discharge letters. Departmental induction also encompasses local information on discharge letter formulation.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 2 · response
Published 26 September 2023

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

Improve discharge-summary completion rates and ensure summaries are sent within 24 hours of relevant attendance.

Verbatim wording from the response

“The Trust wide discharge summary working group will be shortly relaunched with a plan to have primary care representation to try and further refine discharge processes and communication with primary care. There is potential to develop more discharge summary templates for specific specialties or conditions. We are continually working on improving the completion rates of discharge summaries and ensuring they are sent in accordance with the NHS Standard Contract agreement of within 24 hours following inpatient, day case or ED attendance.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 3 · response
Published 26 September 2023

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

Use Epic’s Hospital Course function to build discharge summaries from clinicians’ real-time inpatient documentation.

Verbatim wording from the response

“The RDUH switched to an electronic patient record (Epic) across its Eastern services in October 2020, which was after the date of this incident. This has led to significant improvements in documentation across inpatient and outpatient encounters. Epic has several features that help improve documentation specifically around discharge:”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 1 · response
Published 26 September 2023

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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

Produce guidance and standard operating procedures for ward teams following the After Visit Summary review.

Verbatim wording from the response

“A working group has been established and will shortly begin meeting to review the use of the AVS across inpatient and outpatient areas across the Trust. Once completed, the group will produce new guidance and Standard Operating Procedures (SOPs) for ward teams, meaning the AVS would be given to the patient and the discharge summary sent electronically to the GP as a matter of routine. It clearly lays out medication changes, follow-up arrangements and can be used to provide patient’s with specific instructions. In this case, clear documentation of fluid intake requirements could have been flagged in this document.”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 2 · response
Published 26 September 2023

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

The Trust considers reviewing every discharge letter by a consultant infeasible because of resource demands, unclear responsibility, delays and risks of error.

Verbatim wording from the response

“Other considerations The Trust has considered whether every discharge letter should be reviewed by a consultant. On balance, this would not seem feasible due to:”

Source location

Response from Royal Devon University Healthcare NHS Foundation Trust
Page 2 · response
Published 26 September 2023

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
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Data last updated 7 September 2026