Accident and emergency departments routinely record a large volume of clinical information in a short period of time. Vital signs, blood tests, imaging and other investigations are central to assessing how unwell a patient is and whether urgent intervention is required. Where abnormal observations or test results are not acted upon appropriately, patients may deteriorate rapidly and suffer avoidable harm.
Failure to act on abnormal observations or test results in A&E is a common feature of clinical negligence claims and is distinct from errors in triage, diagnosis or discharge.
The role of observations and investigations in emergency care
Observations such as heart rate, blood pressure, respiratory rate, oxygen saturation and temperature provide important information about a patient’s physiological state. Abnormal observations may indicate serious illness even where symptoms appear mild.
Similarly, blood tests, imaging and other investigations are used to identify underlying pathology, confirm or exclude diagnoses, and guide treatment decisions. In the emergency setting, timely review and interpretation of results is critical.
Recording information alone is not sufficient. Observations and test results must be reviewed, interpreted and acted upon.
Common failures involving abnormal observations
Failures involving observations can occur in a number of ways. In some cases, abnormal vital signs are recorded but not recognised as concerning. In others, abnormalities are recognised but not escalated or reviewed promptly.
Examples include failure to respond to persistent tachycardia, hypotension, hypoxia or altered consciousness, and failure to reassess patients whose observations are deteriorating over time.
Delays may also occur where observation charts are incomplete, not reviewed by senior staff, or not communicated effectively between members of the clinical team.
Abnormal test results and delayed action
Test results may be abnormal in a way that requires urgent action. This includes blood results indicating infection, organ dysfunction or internal bleeding, and imaging showing fractures, haemorrhage or other acute pathology.
Failures may involve delay in reviewing results, misinterpretation of findings, or failure to initiate appropriate treatment or referral once abnormalities are identified.
In busy departments, delays can arise where results are available but not seen promptly by the treating clinician.
Distinguishing these failures from diagnostic error
Failure to act on abnormal observations or test results is distinct from diagnostic error. In these cases, the abnormality is identified or recorded, but appropriate action is not taken.
For example, blood tests may clearly show infection, but antibiotics are not commenced. Imaging may demonstrate a fracture or internal injury, but referral or admission is delayed.
The focus in these claims is on response rather than recognition.
The legal test in these claims
As with all clinical negligence claims, breach of duty and causation must be established.
Breach of duty involves showing that a reasonably competent clinician would have acted differently in response to the abnormal findings. This may include escalating care, commencing treatment, arranging admission or seeking senior or specialist review.
Expert emergency medicine evidence is required to assess whether the response fell below an acceptable standard.
Causation involves establishing that the failure to act caused harm or materially worsened the outcome. This often involves analysing how the patient’s condition progressed during the period of inaction.
The role of escalation and communication
Many cases involve failures of escalation or communication. Abnormal findings may be recorded by one member of staff but not communicated effectively to others.
Delays in senior review, failure to hand over concerns at shift change, and lack of clarity about responsibility can all contribute to failures to act.
From a legal perspective, systemic failures may be as important as individual errors.
System pressures and workload
High workload and staffing pressures are frequently cited in cases involving delayed action. While these pressures provide context, they do not remove the duty to provide reasonable care.
Trusts may be liable where systems fail to ensure that abnormal results are acted upon in a timely manner.
Evidence in claims involving abnormal observations or results
Medical records are central to these claims. Observation charts, blood results, imaging reports and electronic time stamps are used to reconstruct events.
Expert evidence is required to interpret the significance of the abnormalities and to assess what action should have been taken.
Witness evidence may assist in clarifying delays or communication failures.
The consequences of delayed action
Failure to act on abnormal observations or test results can result in avoidable deterioration, delayed treatment and more severe injury. In some cases, early intervention would have prevented escalation to critical illness.
Even where the outcome might not have been entirely avoidable, delay may have caused additional suffering or reduced the chances of recovery.
How we can help
We regularly advise individuals and families in cases involving concerns about failure to act on abnormal observations or test results in emergency departments.
An initial discussion allows us to review the A&E attendance, consider how observations and results were managed, and advise on whether further investigation is appropriate. Where a claim is pursued, we work with appropriate experts to assess whether delayed or inadequate response caused avoidable harm.
If you would like to discuss concerns about care received in A&E, please contact us to arrange an initial consultation in confidence.
Samuel nurse
Clinical Negligence Paralegal
Samuel Nurse is a clinical negligence paralegal progressing his legal career through the CILEX route. In his role he focuses on developing a strong understanding of complex medical issues, applying analytical skills and attention to detail to support the progression of claims. His earlier experience at a nursing expert witness company gave him valuable exposure to clinical negligence work and the importance of expert evidence in litigation, which now informs his approach as a paralegal.
