Incident: Clinical Incidents Due to Computer System Problems at GSTS Pathology

Published Date: 2012-09-30

Postmortem Analysis
Timeline 1. The software failure incident mentioned in the article occurred in January 2012 [14650].
System 1. Computer system caused problems leading to incidents such as inappropriate blood transfusion and incorrect kidney damage results [14650].
Responsible Organization 1. The software failure incident at GSTS's St Thomas' labs was caused by a computer system, which led to various clinical incidents such as inappropriate blood transfusion and incorrect calculation of kidney damage results [14650].
Impacted Organization 1. GSTS Pathology, a joint venture between Serco and King's College and St Thomas' hospitals [14650]
Software Causes 1. A computer system caused problems leading to incidents such as a patient receiving inappropriate blood due to patient history not being flagged [14650]. 2. Kidney damage results were calculated incorrectly after a software fault, which was highlighted as a "near miss" [14650]. 3. The lab's blood group analysers had to be shut for four days after being infected by a computer virus [14650].
Non-software Causes 1. Lack of proper training and supervision of staff as highlighted by the Care Quality Commission in June [14650]. 2. Deficient competency levels of some staff leading to potential exposure to harmful bacteria, as found by the Health and Safety Executive [14650]. 3. Underestimation of the challenges of running the service by senior managers [14650]. 4. Financial losses due to higher than expected laboratory costs [14650]. 5. Lack of investment in new technologies causing frustrations among clinicians [14650].
Impacts 1. In January 2012, a patient received inappropriate blood due to patient history not being flagged as a result of a software fault [14650]. 2. In May 2012, kidney damage results were calculated incorrectly after a software fault, which was highlighted as a "near miss" [14650]. 3. In the same month, the lab's blood group analysers had to be shut down for four days after being infected by a computer virus [14650].
Preventions 1. Implementing thorough testing procedures before deploying the software system could have helped identify and address potential issues before they impacted patient care [14650]. 2. Regularly updating and maintaining the computer systems to ensure they are secure and free from vulnerabilities that could lead to incidents like computer viruses infecting critical equipment [14650]. 3. Providing adequate training to staff on how to use the software effectively and flag potential issues, such as patient history not being properly flagged in the system, to prevent errors in patient care [14650].
Fixes 1. Implement a thorough review and overhaul of the computer system that caused problems leading to clinical incidents, such as inappropriate blood transfusion and incorrect test results [14650]. 2. Enhance training and supervision of staff to ensure proper handling of samples and accurate test results [14650]. 3. Invest in new technologies to improve efficiency and accuracy in pathology services [14650]. 4. Tighten procedures to ensure compliance with regulations and standards, particularly in staff training and competency levels [14650].
References 1. Documents obtained under the Freedom of Information Act by Corporate Watch [14650] 2. GSTS accounts [14650]

Software Taxonomy of Faults

Category Option Rationale
Recurring one_organization (a) The software failure incident happened again at one_organization: The article mentions that in May 2012, a software fault caused kidney damage results to be calculated incorrectly at GSTS's St Thomas' labs. This incident was highlighted as a "near miss" and appropriate action was taken to learn from it [14650]. (b) The software failure incident happened again at multiple_organization: The article does not provide specific information about similar incidents happening at other organizations or with their products and services.
Phase (Design/Operation) design, operation (a) The software failure incident related to the design phase can be seen in the article where it mentions that in May 2012, kidney damage results were calculated incorrectly after a software fault, which GSTS highlighted as a "near miss" and took appropriate action to learn from it. This incident points to a failure introduced during the design or development phase of the software system [14650]. (b) The software failure incident related to the operation phase is evident in the article where it describes an incident in January 2012 where a patient received inappropriate blood due to patient history not being flagged. This incident occurred due to an operational issue or misuse of the system, indicating a failure introduced during the operation of the software system [14650].
Boundary (Internal/External) within_system (a) within_system: The software failure incident at GSTS's St Thomas' labs in 2012 was caused by a computer system that led to various issues. For example, a patient received inappropriate blood due to patient history not being flagged, kidney damage results were calculated incorrectly after a software fault, and the lab's blood group analysers had to be shut for four days after being infected by a computer virus [14650]. These incidents highlight failures within the system's software that directly impacted patient care and laboratory operations.
Nature (Human/Non-human) non-human_actions, human_actions (a) The software failure incident occurring due to non-human actions: - The Corporate Watch investigation revealed that a computer system caused problems, leading to incidents such as a patient receiving inappropriate blood and incorrect kidney damage results due to a software fault [14650]. - The lab's blood group analysers had to be shut for four days after being infected by a computer virus [14650]. (b) The software failure incident occurring due to human actions: - The article mentions that GSTS management admitted the venture "did not get off to a great start" and "the corporate functions have not always provided a joined-up service" [14650]. - It is highlighted that senior managers underestimated the challenges of running the service and acknowledged clinicians' frustrations, in part due to lack of investment in new technologies [14650].
Dimension (Hardware/Software) hardware, software (a) The software failure incident occurring due to hardware: - The article mentions that in May 2012, the lab's blood group analysers had to be shut for four days after being infected by a computer virus [14650]. - The incident of kidney damage results being calculated incorrectly in May 2012 was attributed to a software fault [14650]. (b) The software failure incident occurring due to software: - The incident in January 2012 where a patient received inappropriate blood was attributed to patient history not being flagged due to a computer system issue [14650]. - The article highlights that the software fault in May 2012 led to incorrect kidney damage results [14650].
Objective (Malicious/Non-malicious) non-malicious (a) The articles do not mention any malicious software failure incidents where the contributing factors were introduced by humans with the intent to harm the system [14650]. (b) The articles do mention non-malicious software failure incidents. For example, in May 2012, kidney damage results were calculated incorrectly after a software fault, which was highlighted as a "near miss" [14650]. Additionally, in January 2012, a patient received inappropriate blood due to patient history not being flagged, which was also attributed to a software issue [14650].
Intent (Poor/Accidental Decisions) poor_decisions, accidental_decisions (a) The software failure incident at GSTS's St Thomas' labs in May 2012, where kidney damage results were calculated incorrectly after a software fault, can be attributed to poor decisions made in the management of the pathology services. The incident was highlighted as a "near miss," indicating that the software issue could have had serious consequences for patients if not caught in time [14650]. (b) The software failure incident in January 2012, where a patient received inappropriate blood due to patient history not being flagged, can be linked to accidental decisions or mistakes made in the implementation or use of the software system. This incident was taken very seriously by the company, suggesting that it was an unintended consequence of the software not functioning as intended [14650].
Capability (Incompetence/Accidental) development_incompetence, accidental (a) The software failure incident related to development incompetence is evident in the article. The Corporate Watch investigation revealed that a computer system caused problems leading to various clinical incidents at GSTS's St Thomas' labs, including incidents like losing and mislabelling samples, exceeding agreed turnaround times for tests, and critical risk levels being breached [14650]. Additionally, in May 2012, kidney damage results were calculated incorrectly after a software fault, which was highlighted as a "near miss" by GSTS [14650]. (b) The software failure incident related to accidental factors is also present in the articles. For instance, in January 2012, a patient received inappropriate blood due to patient history not being flagged, which was described as an incident that the company took very seriously [14650]. Furthermore, in the same month, the lab's blood group analysers had to be shut down for four days after being infected by a computer virus, indicating an accidental software failure incident [14650].
Duration temporary The software failure incident mentioned in the articles appears to have caused temporary disruptions rather than being a permanent failure. The incident in January 2012 where a patient received inappropriate blood due to patient history not being flagged was highlighted as a serious incident that the company took very seriously [14650]. Additionally, in May 2012, kidney damage results were calculated incorrectly after a software fault, which was categorized as a "near miss," and appropriate actions were taken to learn from it [14650]. These incidents suggest that the software failures were temporary in nature and were addressed to prevent further occurrences.
Behaviour omission, value (a) crash: The article mentions a software fault in May 2012 that led to kidney damage results being calculated incorrectly after a software fault, which was highlighted as a "near miss" [14650]. (b) omission: The article discusses incidents where the system lost and mislabeled samples, and exceeded agreed monthly turnaround times for tests, with critical risk levels breached multiple times [14650]. (c) timing: There is no specific mention of a timing-related failure in the articles. (d) value: The incident in January 2012 where a patient received inappropriate blood due to patient history not being flagged indicates a failure in the system performing its intended functions incorrectly [14650]. (e) byzantine: The article does not provide information about the system behaving erroneously with inconsistent responses and interactions. (f) other: The article does not describe a behavior that falls under the "other" category.

IoT System Layer

Layer Option Rationale
Perception None None
Communication None None
Application None None

Other Details

Category Option Rationale
Consequence no_consequence (a) death: There is no mention of any deaths resulting from the software failure incident in the provided article [14650].
Domain health (a) The failed system was related to the health industry, specifically the pathology services within the NHS. The software failures at GSTS's St Thomas' labs were reported to have caused incidents such as inappropriate blood transfusions, incorrect calculation of kidney damage results, and a computer virus infecting the blood group analysers [Article 14650]. These incidents highlight the critical role of software systems in supporting healthcare services and the potential risks associated with failures in such systems.

Sources

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