NHS England is reviewing its triage training for call handlers after a North London woman died from brain damage following a 111 call that advised home care for post-surgery vomiting. Muluembet 'Mulu' Yohanes, 53, died on February 25, 2025, from complications after minimally invasive brain surgery. An inquest concluded she died from pneumonia following a stroke and seizure, brought on by critically low sodium levels after the operation to remove a non-cancerous brain tumour.
Red flag symptom ignored
Ms Yohanes began experiencing intermittent vomiting three days after being discharged from University College London Hospital (UCLH) in Camden in January 2025. Clinical staff had advised her on discharge that vomiting would be a 'red flag' requiring urgent medical attention. The next day, her son called NHS 111 and was told to treat the symptoms at home. He called again the following day and was advised to bring her to A&E if vomiting continued. Two hours later, she was found unresponsive, and by the time paramedics arrived she was in cardiac arrest.
Ms Yohanes was resuscitated, but doctors found her sodium levels were critically low and the lack of oxygen had caused irreversible brain damage. Assistant Coroner Melanie Lee said it was likely Ms Yohanes had suffered a seizure, though it was impossible to say if earlier intervention could have prevented her death. The coroner has written to NHS England warning that potential flaws in the 111 service could put lives at risk.
Coroner flags call handling errors
The coroner noted that the call handler incorrectly recorded Ms Yohanes's surgery as 'head injury' and failed to ask if she had received 'discharge, worsening or red flag advice' from the UCLH surgery team. 'Had they done so, this may have prompted Mulu to review the written discharge advice she had been given,' the coroner concluded. The London Ambulance Service recommended that NHS Pathways, the clinical support system used by the health service, include prompts for neurosurgery under 'head injury' or 'vomiting'. The coroner advised that NHS Pathways should include neurosurgery rather than leave call handlers to choose the most appropriate pathway.
NHS response and review
NHS England declined to make that change, stating its triage tool is 'not diagnostic' and works by ruling out more serious causes of symptoms. The health body said NHS Pathways deliberately does not reference specific conditions because existing questions identify symptoms that 'indicate onward need for care', such as confusion, drowsiness, and abnormal responses. It added that all health advisors must complete training for using the call line, including guidance on recent hospital discharge.
However, the NHS agreed with the coroner that Ms Yohanes's vomiting should not have been assessed as resulting from a 'head injury'. In light of the case, the NHS is reviewing the training for one of its pathways to ensure call handlers consider whether callers have been given post-operative instructions.
