Summary
Mr C was an older man with multiple health problems; in July 2013 he suffered a fall at home and fractured his hip. He was taken to his local hospital, with the intention being he should be transferred to Raigmore Hospital for surgery. Mr C was not transferred until two days after the fall, and surgery was performed three days after the fall. He spent time recovering in another hospital after the surgery, and was discharged in August 2013. Mr C died in May 2014.
Mr C's wife (Mrs C) complained to Highland NHS Board (the Board) about the length of time taken to transfer Mr C to Raigmore Hospital, particularly taking into account the amount of pain relief that he was being given at the local hospital. She felt he should have had surgery within one day, given his multiple health problems, and that the delay and use of pain relief had contributed to his poor recovery and subsequent decline in health. The Board apologised for the distress caused and said that due to bed pressures it had not been possible to transfer Mr C earlier, but that appropriate care was being given by the local hospital and that there had been no detrimental effect on Mr C. I obtained further information about the other hip operations being performed over the relevant period. The Board said those operated on earlier had been admitted to Raigmore Hospital directly, and that Mr C's transfer had been delayed further by a lack of available orthopaedic receiving beds.
My investigation found that whilst the standard of care provided at the local hospital was reasonable, the delayed transfer meant Mr C received a large quantity of morphine, which has potential side effects which Mr C went on to suffer. In addition, the local hospital did not have the facilities required to provide the type of care outlined within the relevant national guidelines for patients with hip fractures. I found that Mr C was an emergency trauma patient and that, despite the Board's position that such patients would be prioritised over routine and elective patients, he was not prioritised appropriately. The information provided about the other procedures performed over the relevant period indicated there were no issues with theatre or surgical team availability. Mr C had to wait on the basis that he was admitted to a local hospital rather than Raigmore Hospital directly. The importance of the timing of such surgery, in terms of the outcome, is also highlighted in the relevant national guidelines. I was critical of the Board's actions, particularly given the adverse outcome for Mr C.
Redress and recommendations
The Ombudsman recommends that the Board:
- (i) provide evidence that they have procedures in place to ensure that when emergency trauma patients require transfer to an orthopaedic unit for treatment, they appropriately prioritise in accordance with their clinical need;
- (ii) carry out an audit of the last 50 patients admitted to Raigmore Hospital for hip fracture surgery and detailing those who presented at the emergency department (at Raigmore Hospital) and those who presented elsewhere and required transfer;
- (iii) bring the Medical Adviser's comments to the attention of the bed management team (at Raigmore Hospital) and the relevant medical director; and
- (iv) apologise to Mrs C for the failures this investigation identified.