Unidentified but Not Unknown: Evaluating the Phonetic Naming System in a UK Trauma Centre

Background Unidentified or "unknown" patients present significant safety challenges in emergency and trauma care. Structured alias systems aim to reduce misidentification, but practical issues in their use are not well understood. This review evaluated local naming practices for unidentified patients and explored staff experiences with the phonetic alias system at a UK tertiary trauma centre. Methods A mixed-methods review combined policy analysis, a three-month audit of trauma admissions, and an anonymous staff survey (n = 25). The survey captured professional role, experience, perceived safety, training adequacy, and operational challenges. Quantitative data were analysed descriptively, and free-text comments underwent thematic analysis. Results Most unidentified patients were young male trauma cases requiring airway support. The NATO phonetic naming system was consistently applied and reduced duplication, but documentation of alias assignment and record merging was inconsistent. Staff generally perceived the system as safe (72% rated "good/excellent"), though only 40% felt adequately trained. Free-text responses highlighted confusion between similar-sounding aliases, insufficient training, record-merging errors, and the need for clearer protocols and improved electronic integration. Conclusion Structured phonetic naming supports patient safety, but remains vulnerable to human and process variability. Standardised guidance, embedded training, and better digital integration could strengthen reliability, and ensure unidentified-patient management remains safe, efficient, and respectful.