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How is harm defined?

Putting Things Right provides guidance to the NHS on the definitions of harm in relation to PSI’s.  There are 5 categories of harm within the guidance;

  • No harm
  • Low harm
  • Moderate harm
  • Severe harm
  • Death

Establishing the exact degree of harm caused by the incident will often require patient and/or family input into the assessment.  In broad terms harm is described as something that was caused by the COVID-19 infection;

Low Harm:

  • Increase in length of stay (in hospital or healthcare setting) by up to 3 days
  • Minor implications for patient safety
  • Return for minor treatment, or extra investigations.


  • Avoidable injury/damage that requires clinical intervention
  • Additional clinical intervention for patients already receiving healthcare prior to acquiring COVID-19
  • Increase in length of stay (in hospital or healthcare setting) as an In-patient by at least 4 days. 

Severe Harm:

  • Permanent harm that could have been avoided
  • Additional interventions such as ITU (Intensive Therapy Unit) care, that could have been avoided
  • Cancellation or significant delay in urgent care
  • At least 15 days increase in hospital stay.


The death of someone who has tested positive becomes progressively less likely to be directly due to COVID-19 as time passes, and more likely to be due to another cause. However, there is no agreed cut-off after which COVID-19 can be excluded as a likely cause and sadly, some people die from their infection many weeks later.

The framework provides reference to World Health Organisation guidance to help determine how responsible COVID-19 was to a patient’s sad death, particularly when other health issues existed before the COVID-19 infection was caught.  Where death has occurred, investigations will consider the findings of mortality reviews and medical examiners reviews to determine to what extent COVID-19 caused the death.