_ (1) Ms Kreichgauer left the department without given antibiotics. The reason for this appears to have been that no-one did a final check on what treatment was considered and whether this had been given to her: (2) The junior doctor who saw Ms Kreichgauer used an internet resource called 'Uptodate". The evidence was that the Trust supplies the subscription for this He searched under the phrase "cat bite" and was directed to a diagnosis of cat scratch fever. On this basis he planned to prescribe azithromycin. In fact; the correct diagnosis was that Ms Kreichgauer had an infected cat bite; the infective organism for this is different to the organism causing cat scratch fever; and the appropriate treatment is different: Even if she had been given antibiotics it is therefore likely that these would not have been effective At the inquest the clinicians accepted that it would be helpful for there to be a warning on Uptodate pointing out the_ need to consider the possibility of infected cat bite (and the The being important difference between this and cat scratch fever) when searching under either term ("cat bite" or "cat scratch". It was accepted that the Trust should be in a position to communicate with Uptodate to point out this concern.

(3) There does not appear to be a feedback mechanism within Uptodate to allow clinicians to notify it of any concerns. Again, as a subscriber to Uptodate; this is a matter that the Trust is likely to be in a position to take up with them