Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England

Prisoners have disproportionately poorer health and complex needs compared to the general population. Prisons should provide care that is equivalent to community care to achieve equitable health outcomes, which includes managing physical deterioration. To characterise safety incidents involving critically unwell prisoners and identify opportunities to improve prison healthcare systems. A secondary mixed-method analysis of incident reports submitted from English prisons between 2018-2019. The patient safety incidents were previously characterised, describing incident types, contributory factors and outcomes. Purposive sampling of these coded data was carried out using search terms to identify healthcare-associated harm, or near misses, related to critical illness (ill health with risk of death if urgent care is not provided). Included reports were sequentially analysed by descriptive and Framework Analysis. Of 4112 reports submitted within 12 months, 983 (23.9%) were identified by the search terms and screened, and 94 (9.6%) met the inclusion criteria for analysis. Most incidents resulted in delayed assessment or treatment (46, 36.2%), avoidable hospital admission (15, 11.8%) or patient deterioration (13, 10.8%). Key issues identified were insufficient provision of emergency equipment, failure to recognise severity of symptoms and act appropriately on symptoms and ineffective communication between prisons and ambulance services. Moderate/severe harm outcomes were reported in a quarter of reports (26, 27.7%). System-wide interventions are needed to improve the safety of care delivered to critically ill prisoners, including improved continuity of care, enhanced emergency response training, reviews of emergency protocols surrounding clinical assessments, recognition of critical illness, escalation plans and communication with wider teams.