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recurance

Steven Amos

6 Apr 2017 · Coroner Katy Skerrett · Gloucestershire

This report repeats 1 earlier warning. See the linked reports.

The coroner's concerns

  1. 1. lack of appropriate escalation of care

    “appropriate escalation of care given to a patient who acutely deteriorates during the night shifts over the weekend period”

Linked reports

Repeats an earlier warningSamantha Beach21 Oct 2015 · 1 year 6 months earlier
Closely relatedConfidence 0.90 · high

Earlier report

“The clinical care provided to [name redacted] in the obstetric department was not escalated appropriately to more senior colleagues,”
Original on judiciary.uk ↗

This report

“Whether there is appropriate escalation of care given to a patient who acutely deteriorates during the night shifts over the weekend period.”
Full chain: Inadequate escalation of clinical care

Responses

No published response was found on judiciary.uk.

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error

Steven Amos · Recurance