A  report into inconsistencies in thousands of patient records at Nottingham University Hospitals NHS Trust has revealed that pressures to meet government targets led to “bending of the rules.”

According to the report, which was commissioned by NHS East Midlands following discrepancies that were identified by the chief executive of the trust last year, almost 2,000 records were altered between April 2008 and April 2009.

The report by Dearden Consulting says that records were changed in the emergency department at Queen’s Medical Centre to show that patients were treated, transferred or discharged within government’s four hour target.

It says: “There was considerable pressure in the trust to hit the four hour target in ED which led to the bending of rules in terms of discharge times.”

The report adds that there was also a lack of formal communication and training for ED staff in the guidance in collection of data relating to discharge time and that there were inadequate systems in place for staff to raise issues and concerns from the frontline.

The report also highlights the need for an audit trail of patient discharge times to prevent similar events happening in the future. “Had an audit taken place, it would have highlighted earlier the data reporting anomalies which have instigated this review,” it says.

The trust has been using iSoft’s emergency department information system (EDIS) since 2004 to automate triage patient tracking, order and results, documentation and discharge and to also provide patients with an electronic record.

The document recommends that the trust should ensure that key systems, such as iSoft’s EDIS (emergency department information system) have a functioning audit system so that changes made to information are recorded and can be tracked back to an individual.

It adds that the trust and the strategic health authority should consider how best to influence software provider, iSoft, to create an audit trail to enable EDIS to be effectively monitored.

The trust told E-Health Insider that it has now implemented a script within the system that gives the trust more detailed audit information, including the name of the person who alters information and the date and time that they do so.

The report makes clear that there is no evidence of misreporting against other patient standards such as 18 week waits and says that they are satisfied that patient safety was put first.

Peter Homa, chief executive of Nottingham University Hospitals NHS Trust, said: “The report makes it absolutely clear that patient safety and the quality of care has always been the trust’s top priority.

“What both reports show is that our internal processes and rules for recording when patients left our emergency department were not as robust as they should have been.

"On behalf of the trust I apologise for this lapse in data management. We have already put in place additional measures to ensure such problems cannot happen again.”



Dearden review