Daily Post article, by Gareth Hughes, 12 January 2017:  Coroner questions bed-blocking at Maelor Hospital after woman accidentally killed herself in A&E

A coroner is to ask what steps are being taken to tackle the problem of  bed-blocking at the Maelor Hospital, Wrexham. John Gittins, the coroner for North Wales East and Central, issued a Regulation 28 notice after hearing the situation was probably worse today than two years ago.

Julie Smith, assistant director for nursing with the Betsi Cadwaladr University Health Board, told an inquest that demand for beds constantly exceeded supply despite various efforts to solve the problem. ‘It is an absolutely massive challenge but we are doing our best to manage the pressure,’ she said.

Mrs Smith was giving evidence at an inquest into the death of mother-of-four Sarah Ann Tyler, who accidentally killed herself in the hospital’s emergency department where she had been on a trolley for about eight hours, having been admitted after taking an
overdose of paracetamol.

Miss Tyler, of Ffordd y Gaer, Bradley, was found unconscious with a ligature made of an ECG cable around her neck in the early hours of February 9, 2015.

The hearing was told that she had been suffering from depression and severe ME (myalgic encephalomyelitis) which had left her bed-bound. In a statement read at the inquest her partner David Millward, who was father to her four children, said she was virtually unable to move and was upset at being unable to care for her children. He said she was convinced that the chronic fatigue, not a mental health issue, was her main problem and she felt she was not receiving the specialist treatment for her condition.

In August, 2014, her son found her with a bungee cord around her neck and on February 9 Mr Millward found her with a phone charger cord around her neck, so called the out-of-hours doctor. In the doctor’s presence she took an overdose of paracetamol and Cocodamol and so she was admitted to the emergency department, where she refused to engage with staff. While lying on the trolley she disconnected her intra-venous drip
several times, claiming it had fallen out.

Senior House Officer Dr Thomas Minton told the inquest: ‘I explained what the risks were but she was not giving me anything back.’ Staff nurse Kate Roberts said that Miss Tyler was under half-hourly observation because of the tablets she had taken and was last seen at about 12.20am. About 15 minutes later she was found hanging and despite attempts to resuscitate her she died the following day.

Mrs Smith, who was involved in the serious incident review following the tragedy, said various steps had been taken as a result. These included psychiatric nurses being involved in assessment at a much earlier stage when a patient who has selfharmed arrives in the emergency department.

‘Two years ago nurses used their own professional judgment,’ she said.

Asked by the coroner whether such an incident was less likely to occur now, Mrs Smith replied: ‘Yes, I believe we have reduced the risk, though the improvements are on-going.’ Mr Gittins said his initial fears regarding observation of patients had been allayed but he remained concerned about the severe problem of finding beds for patients, even though he did not believe it played a part in Miss Tyler’s death.

‘Patient throughput continues to be a problem and perhaps even greater now than it was two years ago. I believe it does create a risk,’ he added. He recorded a conclusion of accidental death on Miss Tyler, a cleaner, as he was not persuaded that she wanted to kill herself as she had taken the action in a place where she could expect to be found.