"My father's ED experience"

My father was brought to the Emergency Department at the Ulster Hospital by emergency ambulance following a collapse, query uro-sepsis given a significant history of the same.

Following initial handover to the triage nurse, where the significant history of uro-sepsis following collapse was communicated, we were left in the ambulance to wait without any further interaction from ED staff for 8.5 hours. Twice a deterioration was highlighted with an increase in the NEWS2 score which should have initiated escalation to a senior clinician, however still there was no further intervention from ED staff.

As per NICE guidelines, this should have been recognised as suspected sepsis with high risk criteria present, triggering an immediate review by a senior clinical decision maker (emergency care ST4 or above or equivalent) and venous blood tests carried out in a timely manner. Intravenous antibiotics should have been administered without delay and the case discussed with a consultant. My father waited 8.5 hours after recognition of potential sepsis by the ambulance service until any of the systems in place were initiated, showing what I feel was a complete breakdown in patient care.

I am acutely aware of the pressure the entire health and social care system faces, so I am realistic to expect delays. This case however, warrants highlighting, as I feel it was a fundamental failing to implement a nationally recognised risk stratification tool in place to identify acutely unwell patients and mitigate severe illness or death from sepsis. In my view, it is also these lengthy delays that ultimately lead to poor response times from the ambulance service as a majority of crews are committed to looking after patients outside of Emergency Departments. 

Once in the department it was felt as though, despite the new Encompass system, previous encounters were not given enough consideration. My father presents slightly atypically in terms of test results compared to clinical presentation, but this should be well documented in his notes. Considering he is under the care of a Consultant Urologist, there never appears to be any tangible treatment plan and each presentation to the Emergency Department feels like the medical team are trying to work out a plan for the first time. The urology team have also never seen him on any of his presentations with uro-sepsis in the Emergency Department. 

Please be assured I have nothing bad to say about the hard-working frontline staff in a broken system, but I feel compelled to highlight critical failings within the unscheduled care system which urgently need to be addressed. If no resolution is sought as a priority, I believe patients will continue to suffer and ultimately unnecessary and preventable deaths will occur.