Hazard¶

DO NOT EDIT BELOW THIS LINE UNLESS YOU KNOW WHAT YOU ARE DOING

Hazard name¶

Missing letters in list

General utility label¶

[2]

Likelihood scoring¶

TBC

Severity scoring¶

TBC

Description¶

Letters list page displays letters from EHRbase AQL query but does not handle pagination limits or auto-refresh, potentially missing recent letters if query has default row limit or letters created during page load.

Causes¶

AQL query may have default row limit (e.g., 100 letters)
Letters created during page load not shown until manual refresh
No "refresh" button or auto-refresh mechanism in UI

Effect¶

Clinician does not see most recent clinical letter in letters list, believes they have reviewed all available clinical information.

Hazard¶

Critical clinical information in recent letter not reviewed before making clinical decision (e.g., recent consultant letter documenting contraindication).

Hazard type¶

WrongPatientContext

Harm¶

Clinician prescribes medication that conflicts with contraindication documented in unseen letter, causing adverse drug reaction or treatment failure.

Existing controls¶

None identified during initial analysis.

Assignment¶

Clinical Safety Officer

Labelling¶

TBC (awaiting scoring)

Project¶

Clinical Risk Management

Hazard controls¶

Design controls (manufacturer)¶

Add explicit LIMIT and OFFSET clauses to EHRbase AQL query with pagination controls: display "Showing 1-50 of 150 letters" with Next/Previous buttons. Fetch total count in separate query.
Implement automatic polling: refetch letters list every 60 seconds while page is active using React Query refetchInterval. Display timestamp "Last refreshed: 14:35:22" with manual refresh button.
Add "Load more" button at bottom of letters list if pagination indicates more letters available. Display warning banner if letters count exceeds single page: "More letters available - click Load More."
Sort letters by creation date descending (newest first) to ensure most recent clinical information appears at top of list.
Add visual indicator when new letters created: display notification badge "+2 new letters" with auto-scroll to top option.

Testing controls (manufacturer)¶

Integration test: Create 150 letters for patient, load letters page. Assert only first 50 displayed with "Load More" button visible. Click button, assert next 50 letters loaded. Verify total count shows 150.
Integration test: Load letters page, create new letter via API in background (simulating different user), wait 70 seconds (>1 polling interval). Assert new letter appears in list automatically without manual refresh.
Unit test: Mock AQL query to return total count of 200 letters but only 50 results. Assert pagination UI displays correct count "Showing 1-50 of 200" and enables Next button.
Integration test: Create letter at timestamp T0, load letters page at T1 (after T0). Verify letter created at T0 appears in list at T1 (no missing letter from timing race).

Training controls (deployment)¶

Train clinicians to always check total letters count and use pagination to review complete clinical history before making high-risk treatment decisions.
Document workflow: "Before prescribing new medication, review all available letters by clicking 'Load More' until full history reviewed. Check timestamp to ensure recent letters not missed."
Include in clinical handover training: "When reviewing patient history, verify you've seen all letters by checking 'Showing X of Y' counter. Don't assume first page shows everything."

Business process controls (deployment)¶

NHS Trust policy: Before high-risk treatments (chemotherapy, anticoagulation, biologics), clinician must document review of complete clinical letter history including pagination confirmation.
Clinical governance: Medical records team must audit letter completeness quarterly, verifying all clinical letters properly indexed in EHRbase and accessible via Quill interface.
IT SLA: Letters created must appear in patient's letter list within 2 minutes of creation (either via polling or WebSocket notification). Monitor and alert on indexing delays.

Residual hazard risk assessment¶

TBC — awaiting initial controls implementation.

Hazard status¶

Draft from LLM

Code associated with hazard¶

frontend/src/pages/Letters.tsx