Coroner warns poor communication between hospital specialists and GPs ‘risks future deaths’

iStock/DNY59

By Lily Canter

A coroner has warned that unclear communication of treatment plans between hospital specialists and GPs could lead to future deaths.

A lack of clarity in a consultant’s letter to a GP over prescribing a treatment contributed to a patient waiting more than a year for the drug, an inquest has heard.

In a prevention of future deaths report sent to the Department of Health and Social Care, assistant coroner James Thompson said communication concerns arose following the death of Theresa Lydon from an intra-abdominal haemorrhage. She died in September 2022 following surgery for ulcerative colitis at South Tyneside District General Hospital.

A number of failings in her care were identified by Thompson, including the significance of her ulcerative colitis not being recognised during her hospital visits in August until her fourth and final visit.

The inquest recorded a narrative conclusion of neglect.

Lydon was diagnosed with ulcerative colitis in May 2021 and prescribed balsalazide. However, the drug was not issued until June 2022 after the prescription was missed.