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Case ref:201501222
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Date:May 2016
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Body:Greater Glasgow and Clyde NHS Board - Acute Services Division
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Sector:Health
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Outcome:Not upheld, recommendations
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Subject:clinical treatment / diagnosis
Summary
Ms C complained about the care and treatment she received from the Early Pregnancy Assessment Service (EPAS) at the former Southern General Hospital in Glasgow following a positive pregnancy test. Ms C had been referred to the EPAS by her GP practice as she was in the early stages of pregnancy and had a three-week history of constipation, vaginal bleeding and abdominal pain. When Ms C called the EPAS, a midwife advised her that she may be having a miscarriage and she was given an appointment for the following week to have a scan.
The following evening, Ms C called the EPAS again as she was in pain but as the service was closed her call was passed to a midwife at the maternity assessment unit. Ms C said she was offered no new advice as it was too early in her pregnancy. When Ms C attended her appointment at the EPAS, the scan revealed she had an ectopic pregnancy. As a result, Ms C required emergency surgery. Ms C felt the midwives at the EPAS should have acted sooner.
We took independent advice from a midwife adviser. We found that the midwives involved in Ms C's care and treatment appeared to have followed the relevant guidance which included the health board's Early Pregnancy Assessment (EPA) guidance for dealing with phone calls, and that their actions were reasonable. We also found that there did not appear to have been any unreasonable delay before the scan was carried out as the guidance suggested that women presenting with symptoms like those Ms C presented with are given a non-urgent appointment. We did not identify any failings in Ms C's care and treatment and, therefore, we did not uphold Ms C's complaint. However, we did find some issues with record-keeping and the EPA guidance, and we made recommendations to reflect these findings.
Recommendations
We recommended that the board:
- feed back to relevant staff that advice given to patients should be clearly documented in the patient's medical records and patients are given as much information as possible about what they might expect, especially while they wait for a scan; and
- consider our findings in relation to providing a clear definition in the EPA guidance for specific stages of pregnancy with combinations of symptoms; and 'non urgent' appointments and the women who fall into this category.