Decision Report 201601788

Summary

Ms C complained about the care she received at Forth Valley Royal Hospital after she was admitted via A&E with abdominal pains. While appendicitis was initially suspected, further investigations led staff to believe that Ms C was suffering from problems with her gallbladder. On the second day following her attendance at the hospital, a scan was carried out that showed Ms C's appendix had burst causing an abscess. She was operated on that day but suffered from pleural effusion (excess fluid surrounding the lungs) that had to be treated with a chest drain. Ms C felt that an earlier diagnosis could have resulted in a better outcome.

We took independent advice from a consultant in emergency care and a consultant surgeon. In terms of emergency care, we found that Ms C had received appropriate care and investigation in A&E. However, we found that whilst it was reasonable that staff had considered Ms C was suffering from a gallbladder issue due to her symptoms, junior staff should have escalated the case when her condition worsened and alternative diagnoses should have been considered at that point. We found that there had been a delay of around 12 hours in diagnosing the cause of Ms C's condition as a result of her care not being escalated to senior staff appropriately. We upheld Ms C's complaint.

Recommendations

We recommended that the board:

• ensure that this case is included for learning purposes at the appraisal of the junior doctor;
• ensure the protocol for escalating patient care to more senior staff is highlighted during the induction of junior doctors; and
• carry out an audit of patients under the care of the surgical team with high national early warning scores to determine whether the escalation process is being appropriately followed.