We conduct analyses of coroners’ Prevention of Future Death reports (PFDs) to identify trends, lessons to reduce avoidable harms and improve public safety.
We have published 20 studies, articles and reports to date, including:
- Song et al. 2023. Preventable deaths involving falls in England and Wales, 2013-2022: a systematic case series of coroners reports. medRxiv. https://doi.org/10.1101/2023.05.27.23290640
- Bremner et al. 2023. A systematic narrative review of coroners’ prevention of future deaths reports (PFDs): a new metric for patient safety. medRxiv. https://doi.org/10.1101/2023.05.19.23290187
- Zhang & Richards. 2023. Lessons from web scraping coroners’ Prevention of Future Deaths reports. Medico-Legal Journal. https://doi.org/10.1177/00258172221141284
- France et al. 2023. Preventable Deaths Involving Medicines: A Systematic Case Series of Coroners’ Reports 2013–22. Drug Safety. https://doi.org/10.1007/s40264-023-01274-8
- Dernie et al. 2022. Preventable deaths involving opioids in England and Wales, 2013-2022: a systematic case series of coroners’ reports. medRxiv. https://doi.org/10.1101/2022.11.16.22282411
- Aronson. 2022. When I use a word . . . Too little healthcare—coroners’ concerns. The BMJ. 379:o2873. https://doi.org/10.1136/bmj.o2873
- Swift et al. 2021. Preventable deaths from SARS-CoV-2 in England and Wales: a systematic case series of coroners’ reports during the COVID-19 pandemic. BMJ Evidence Based Medicine. 27:296-304. http://dx.doi.org/10.1136/bmjebm-2021-111834
- Aronson et al. 2021. Deaths attributed to the use of medications purchased online. BMJ Evidence Based Medicine. 27:60-64. http://dx.doi.org/10.1136/bmjebm-2021-111759
- Anis et al. 2021. Deaths from cardiovascular diseases involving anticoagulants: a systematic synthesis of coroners’ case reports. BJGP Open. https://doi.org/10.3399/BJGPO.2021.0150
- Odgers et al. 2021. Preventable deaths involving cyclists in England and Wales: Solutions to improve their safety. Report: https://www.gchu.org.uk/2021/09/gchu-report-preventable-deaths-involving-cyclists-in-england-and-wales/
- Loo & Richards. 2021. Preventable deaths in Oxford and Oxfordshire. Report: https://www.gchu.org.uk/2021/12/gchu-report-preventable-deaths-in-oxford-and-oxfordshire/
- De La Haye & Richards. 2021. Preventable deaths in the city of Cambridge and Cambridgeshire, UK. Report: https://www.gchu.org.uk/2021/12/gchu-report-preventable-deaths-in-cambridge-and-cambridgeshire/
- Cox & Ferner. 2020. Tramadol: repeated prescriptions and repeated warnings. BMJ Evidence Based Medicine; 26:e17. http://dx.doi.org/10.1136/bmjebm-2020-111661
- Thomas & Richards. 2020. Diclofenac in adolescents: diagnosing and treating gastrointestinal adverse drug reactions can prevent future deaths. BMJ Evidence Based Medicine. http://dx.doi.org/10.1136/bmjebm-2020-111640
- Bilip & Richards. 2020. Emollients and smoking: a fire hazard that could be prevented to reduce future deaths. BMJ Evidence Based Medicine. 26:131-134. http://dx.doi.org/10.1136/bmjebm-2020-111648
- Richards. 2020. Alcohol-based hand sanitisers: a warning to mitigate future poisonings and deaths. BMJ Evidence Based Medicine. 26:65-68. http://dx.doi.org/10.1136/bmjebm-2020-111568
- Richards et al. 2020. Coroners’ concerns to prevent harms: a series of coroners’ case reports to serve patient safety and educate the public, clinicians and policy-makers. BMJ Evidence Based Medicine. 26:37-38. http://dx.doi.org/10.1136/bmjebm-2020-111567
- DeVito et al. 2020. How we learnt to stop worrying and love web scraping. Nature. https://doi.org/10.1038/d41586-020-02558-0
- Ferner et al. 2018. Preventing Future Deaths from Medicines: Responses to Coroners’ Concerns in England and Wales. Drug Safety. 42:445-451. https://doi.org/10.1007/s40264-018-0738-z
- Ferner et al. 2017. Deaths from Medicines: A Systematic Analysis of Coroners’ Reports to Prevent Future Deaths. Drug Safety. 41:103–110. https://doi.org/10.1007/s40264-017-0588-0
If you’d like to commission bespoke analyses, audits or reports of PFDs and their responses, get in touch.