Decision Report 202110695

Summary

C complained about the care and treatment provided to their spouse (A) by the out-of-hours (OOH) service. A had a headache, temperature and dizziness and collapsed twice. The OOH GP spoke with A and A's family and prescribed painkillers for their headache. A later started hallucinating and the OOH service sent an advanced nurse practitioner who diagnosed A with a urine infection. A was later taken to hospital where they died from organ failure a few weeks later.

We took independent advice from a GP. We found that it was reasonable for the GP have carried out a telephone consultation instead of a home visit and that the telephone assessment conducted appears to have been reasonable. We also considered that it was reasonable for the OOH GP to have obtained a medical history from A and A's family and that given the symptoms described and the results of the urine test, the diagnosis of a urine infection was reasonable, as was treatment with antibiotics rather than admission to hospital. We also found it reasonable that a Significant Adverse Event Review was not considered given that there were no direct issues raised with the OOH service at the time of events.

We did not uphold C's complaint but provided feedback to the board that the notes of the telephone consultation were inadequate given that reasonable record keeping is an integral part of patient care.