"Emergency appt to investigate possible toe..."

About: Royal Devon & Exeter Hospital (Wonford)

My friend's GP had arranged an emergency appointment at Exeter to investigate a toe that was badly infected. He is diabetic and the toe had ulcerated. This obviously is serious in diabetics. He had to go to Exeter as Musgrove Park Taunton are a shambles. Upon arrival at Exeter, it became apparent that this was an admission. The Ward Sister was advised that he had not been told about this and whilst he was quite happy to stay that day for the investigations, he would have to go home because he had an appointment the next morning at Frenchay Hospital, Bristol which he had been waiting a long time for, and did not want to miss, but he would happily return to Exeter if required. This was agreed, and a part-admission was carried out. My friend was told he would need an x-ray and some bloods taken, following which he could leave. At that time, he asked for some pain relief. He was duly taken down to x-ray where he waited for over an hour. On his return to the Ward, he was told that someone came to take the bloods whilst he was in x-ray so they would have to come back. After waiting another hour or more, a nurse came to take the bloods. It was now gone 6 pm and the staff nurse was advised that we would need to leave shortly as my friend needed to get home for his insulin as he was beginning to feel unwell and to eat as we had not expected to be out so long. She said he could eat at the hospital, but was told it was no good eating if he didn't have any insulin to take. The pharmacy do not have the insulin needed and said it would take approx 3 days to order it in - if they could even order it as it "was not on their list". Even after all the explanations as to why he was unable to stay he was still marked as "discharged himself" on his records. This was categorically not the case - and just proves a total lack of communication and understanding between the staff. No pain relief was brought at any time. Apparently, a Vascular doctor arrived to see my friend just after we had left - he had not been told that anyone else was coming to see him. When he asked what, then, should he have done if he was beginning to feel unwell and needed to get home for his insulin, the reply was "well you should just have stayed to see the doctor" - total lack of knowledge of diabetes or what? Unbelievable.

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Responses

Response from Patient Engagement & Experience Administrator, Royal Devon and Exeter NHS Foundation Trust

Dear Hannah Hardy

Thank you for sharing your story and I am very sorry for the problems your friend has experienced. We would like the opportunity to discuss this with you both and ask if you can call the Patient Engagement and Experience Team on 01392 402093 or 402071.

Kind regards

Tracy

Response from Royal Devon & Exeter Hospital (Wonford)

Thank you for sharing your story and I am very sorry for the problems your friend has experienced. We would like the opportunity to discuss this with you both and ask if you can call the Patient Engagement and Experience Team on 01392 402093 or 402071. Kind regards Tracy

Response from Royal Devon and Exeter NHS Foundation Trust

Dear Ms Hardy

Thank you for outing the issues your friend had in relation to his recent visit to the RD&E emergency surgical ward for his vascular issues. I am sorry that there was miscommunication regarding this patient’s care. When a GP feels that a patient’s condition is severe enough to require urgent assessment on the Medical Admissions Unit there is always a possibility that the patient will require admission to hospital. We do our best to avoid admissions if clinically appropriate, or if the patient does not wish to stay.

Out target is for all patients who are admitted with foot ulceration and diabetes to have initial appropriate treatment and to be seen by the Multidisciplinary Foot Team (MDT) within 24 hours. The ward and consultants recall the events and would like to reassure you that we tried hard to deal with the very complex presenting condition and underlying diabetes. Your friend was referred as an emergency for assessment and potential treatment, but this clearly wasn’t communicated well during his access to the department.

I am sorry that the patient felt that he could not eat in hospital as he did not have his insulin. It is the case that we don’t always stock every kind of insulin but should your friend have stayed we would have worked hard to ensure a safe treatment for his diabetes was found. We have worked closely to try and complete this episode of care but so far have been unable to agree a satisfactory date to do this. Please be assured we do encounter complex cases in this department frequently and can usually get to a satisfactory outcome.

If you would like to discuss this further please contact our Patient Engagement and Experience Department on 01392 402093.

Lead Consultant Diabetes

Consultant in Acute Medicine

and

Assistant Director of Nursing for Surgical Services

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