"Repeated unpleasant experience for daycase procedure"

I’m writing about my repeated unpleasant experience on admission to the elective treatment centre (ETC) for a procedure in Interventional Radiology (IR). I’m hoping management listens & makes appropriate changes to prevent this happening again. I would like to begin by stating that the healthcare teams on ETC and in IR are compassionate, caring & helpful. This feedback is about what appears to be an ineffective booking system & inadequate/conflicting perioperative advice around nil by mouth for patients undergoing elective treatment with a local anaesthetic.

I had an IR appointment for ureteric stent insertion. I received a confirmation letter from radiology bookings stating my appointment is booked for 2 pm. This letter includes examination-specific preparation which are simply directions to the department which makes it appear that this is an outpatient procedure. I’m already aware that I’m for an overnight stay but the letter causes some confusion and I query this with radiology. Of note the letter also states the incorrect approach to my procedure stating it’s retrograde rather than antegrade. This again causes me some confusion as I’d previously discussed the retrograde approach with the consultant urologist for which a GA is required.

The confirmation letter sent from the bookings for ETC states ‘it is very important you do not eat or drink anything after 2.00 am on the day of your admission, including chewing gum or sweets. You may drink clear water up until 2 hours before your surgery’. I’m already aware that I may have breakfast just before 8 am and clear fluids up until 2 hours before the procedure. I know this from previous advice given from the one of the radiographers before my 1st elective admission this year.

This letter also states to be at the ETC unit for 7 am (I know this is not necessary for an afternoon procedure under local). The radiology list for ureteric stenting is in the afternoon so I do not understand why these letters are continually advising patients to arrive at ETC for 7 am. IR previously stated that patients do not need to arrive at ETC until around 11 am. This appears to be a generic letter sent to all ETC patients without an individual system pathway specific to certain procedures. There have been problems previously on 2 admissions around mixed perioperative advice regarding eating & drinking.

Around 2 pm I was taken to IR for my procedure. The procedure wasn’t done until gone 5 pm, which unfortunately didn’t go to plan. The procedure generally only takes about 30 mins-1 hour. By the time I get back to the ward at gone 7 pm, it is now 8 hours since I last ate for a day case procedure under LA. I’ve stopped drinking clear fluids about 12 midday as required which potentially would leave me without fluids for approximately 6 or more hours. This has resulted in me having to ask for small amounts of fluid and in some cases IV fluids. As a former NHS professional, I know it is not acceptable to leave a patient in this situation where they are worrying about their transplanted kidney because of unclear pathways around fluids.

Earlier this year I was admitted for the same procedure which didn’t go to plan. I stayed in for the procedure which again would be early pm. I was awoken by the ward staff who offered me diet/fluids before 6 am as they had been informed I needed to be completely NBM for the same procedure without any clear fluids at all. I asked the staff to query this as the day before I could have clear fluids up until 2 hours before the procedure and breakfast just before 8 am. I’m a kidney transplant recipient & shouldn’t be without fluids for long periods of time. Somebody in IR spoke to one of the ETC nurse’s and again stated I couldn’t have fluids before the procedure at all.

This is unpleasant enough but because my procedure frequently ends up being unsuccessful on 1st attempt, I end up having to be readmitted or staying in & going through the whole NBM saga again. I’d appreciate if someone in IR can explain why I’m booked at 2 pm & taken to the department (which is warm and humid so increases thirst) where I’ve waited until 5 pm on the 3 occasions I’ve been booked for this procedure.

For some reason my procedure appears to be particularly problematic and on all three occasions there have been issues placing the stent first time. I’m fully aware these procedures can be a challenge to manage, but I fail to understand why I’m repeatedly booked at 2 pm & not having the procedure done until around 5 pm. If my procedure cannot be at around 2 pm I’d rather be booked in later that day with a clear patient pathway so that I’m not left unnecessarily for long periods of time without diet & fluids.

I’m informed each time this should be a simple straightforward procedure. I’d be very grateful if the clinical lead for IR could also contact me to discuss why my procedure appears to be particularly difficult and I have unanswered questions about this. I have other health conditions & these episodes have left me feeling physically/emotionally drained and I also cannot face going through this each time I’m admitted for this elective procedure which will be every 4-6 months. I’m questioning whether I can receive treatment elsewhere and/or other treatment options which I’m going to discuss with my fantastic Transplant team.

I do not want to discuss this through PALS, as although PALS are helpful, concerns take too long & frequently in my view information is misinterpreted. I’d very much appreciate if the matron for the TEIR services and the clinical lead for IR could contact me to discuss these issues & if a number could be left on this feedback for me to phone to arrange this. I’m hoping these issues can be resolved and prevent potential adverse outcomes as a result of being nil by mouth for long periods of time. Thank you.