Response from NHS Lothian:
“Thank you for taking the time to submit your comments about your care and treatment at the Royal Edinburgh Infirmary, I am pleased to hear that you were “very impressed” with the level of care and with the “consistently excellent staff” who provided it. I am sorry to hear that you felt a lack of “ownership” and continuity at each stage of your admission. Please accept my apologies. I agree with you that this is most important and I will share your story with colleagues to learn from it and so help to improve the services we offer.”
Melanie Hornett
Nurse Director
Patient Story:
I have recently had cause to get a good end to end view of the National Health Service Scotland and I would like to describe my case as an illustration of what I feel must be a fairly typical experience.
My interaction started when I passed out at work and my colleagues phoned for an ambulance. Admittedly I had passed out and was quite dizzy but the ambulance car was there so quickly that I remember being very surprised. This seems to be down to the excellent practice of having ambulance cars that can get to the scene and stabilise the patient. The ambulance itself arrived not long after and all the ambulance staff were lovely, despite me being an awkward patient who was determined to do everything herself. They kept me talking all the way to the hospital which was an amazing distraction from the pain, kept me at ease and they explained everything that was happening.
On arriving at Accident and Emergency the ambulance staff handed me over to an A&E doctor who put me in a cubicle. I waited in the cubicle for some time in quite severe pain and it wasn’t until someone noticed I was crying that they started to pay attention to me.
I had already explained that I thought I was having a miscarriage as I was 6 weeks pregnant and there had been a lot of bleeding which seemed to be stopping. However there was still a lot of pain and it was getting much worse. Having taken some observations they then left me but fortunately my husband arrived. He went to get staff to tell them that I had totally blacked out and when they took observations again my blood pressure was very low. As I was no longer bleeding externally and it was at this point I would have expected someone to have flagged my case slightly more urgently but they explained a doctor would be coming to examine me.
The doctor came and checked my womb was not blocked and as it wasn’t, said he would arrange for me to be sent to gynaecology to be checked for an ectopic pregnancy. I then passed out badly again and was moved to resuscitation ward where I was looked after by different staff again. They seemed to just be reacting to my low blood pressure rather than progressing to fix the root cause but they did decide to bring the gynaecologist to me instead of moving me.
I was then moved to a different cubicle with different staff and blacked out again. By this point I had been in A&E for slightly over 2 hours. The gynaecologist arrived and asked why he had not been called with more urgency as it was obvious that I had a ruptured ectopic pregnancy. On his arrival everything started to move quickly and I was being prepared to move to surgery. At this point, despite being semi-conscious someone tried to make me sign a consent form. It is very blurry but I remember not being able to hold the pen but they still tried to make me sign despite my husband offering to do so. My husband eventually did have to sign for me anyway. When the patient is semi-conscious I would have thought standard practice would be to have next of kin sign the form. If not I think this should be looked at as I very much doubt that my consent at that point would have stood, especially as I had also had morphine.
I was then moved to surgery and this was all handled excellently. It was all clearly explained what was happening and despite being scared I felt a strong trust in all those that were looking after me. The surgeon and the anaesthetist were particularly good.
My main concern around my time in A&E is that although the individual staff were all excellent I didn’t feel that anyone took personal ownership of my case and if my husband had not been there I may have passed out without anyone noticing. This was exacerbated by moving me to the resuscitation ward and back as I had 3 different sets of staff who all seemed intent on keeping me conscious which was obviously important. However I felt there was no-one addressing the core issue that such drops in blood pressure surely indicated I was bleeding internally, as there was no external blood loss. I feel someone should have been calling the gynaecologist sooner and with more urgency.
I next came round two hours later in the recovery room where they explained things had gone well and that I would be staying there for a couple of hours while they monitored me as I had lost over 2 litres of blood. I was really pleased when they helpfully explained my husband was upstairs and that my Mum and Dad had been able to collect my 2 year old son which calmed me down to enable me to doze and recover properly. I was moved up to the wards a few hours later where I was settled down for the night. I was very dozy but I felt I had very good attention from a great nurse throughout the night.
My first issue came the following morning when I started to have difficulty breathing and felt very dizzy all the time despite not moving. The nurses were all very busy and despite mustering energy to press the buzzer when they came I just said “dizzy, can’t breathe”. I phoned my husband who came in and encouraged them to put me back on a saline drip which made me feel better. Then an amazing nurse took me under her care and gave me the most thorough attention all day. She not only ensured the blood arrived and was given but had great attention to detail about my comfort and care including ensuring I had my deep vein thrombosis stockings. The best thing though was the small things that I wouldn’t have expected them to do like helping me to clean my teeth and sorting the position of my pillows which make all the difference when you can’t move yourself and are struggling to breathe. The same thing happened again though when she went off shift in that I didn’t feel anyone had any ownership of my care. Ideally she would have handed over to one specific nurse. The following morning, as I was in a room by myself, I was forgotten in the medicine and breakfast round. The process seems to be that one nurse does pills, another does observations etc but this means there is no opportunity to get to know the patient and their individual needs to ensure nothing is missed. I appreciate there may be time savings with this approach but when health and critical recovery times are at stake is a key nurse allocated to a patient not a better approach?
I just feel it is a really unfortunate failure as all the staff that dealt with me were excellent, but without patient ownership this type of error and omission is bound to happen time and again. Also the doctor each morning on the ward was a different doctor who seemed to give a cursory look at the chart and then carry on – would it not be possible to have the same doctor doing rounds for several days at a time to build up a history with the patients?
A positive side was that both the surgeon and anaesthetist came to see me to ensure I was happy with what had happened and what would happen next. The surgeon again was particularly good in that he explained not only what had happened but if I did want to get pregnant again what I needed to do and the risks involved. The nurse I knew was on again for my final day and again looked after me excellently and discharged me.
To summarise, overall I was very impressed with the level of care throughout, particularly the consistently excellent staff who looked after me. I just feel saddened that despite everyone working so well, without true doctor/nurse patient ownership at each step of the process, particularly in A&E and on the ward, the system can never produce its best results despite the hard work of all involved.
