"Delay in having surgery on my ruptured patella tendon"

About: Royal Alexandra Hospital / Trauma & orthopaedics Royal Infirmary of Edinburgh at Little France / Trauma & orthopaedics

(as the patient),

I late May I ruptured my patella tendon. I was taken to the Edinburgh Royal Infirmary A&E Dep't and the transferred to the Day Surgery Ward for boarding - there were no beds in Orthopaedic.

The following day I went for an ultrasound scan on my injured knee and was told that it was "a mess" by the attending doctor - not the best response to be given considering.

Upon my return to the ward the orthopaedic consultant advised me that I would have to wait at least 3-4 days to be seen due to his already full schedule. I advised that I lived in the West and he said that I could go home and then return for surgery or be seen by a hospital in the West. I choose the last option. I was then discharged from the ERI and made my way home in the back of a private car - my leg was in a full brace and supported on the back seat of the car.

I was asked to attend the Royal Alexandria Hospital A&E Dep't at 07: 30 a few days later to begin the process all over again. As I had already seen a consultant in EDI I did not need to see one at the RAH. I was told that I would be scheduled for surgery over the weekend and sent home again. I did not need to fast any more as surgery would not be today.

I returned home and received a call late in the afternoon to advise that my surgery would be on the Sunday. I returned to the RAH at 07: 30 on the Sunday and was admitted to Ward 23. The consultant was Miss Smith - this was the first and only time I have seen the consultant during my stay.

My surgery was delayed until the following day and all seemed fine at the time. For pain relief I was given 2 co-codamol at bed time. At approx. 2 am I was awakened by the excruciating pain in my leg. Clearly the morphine injections had worn off, at surgery, and now the full blown effect of the injury was being felt. I called for the nurse on two occasions and was finally given Oxynorm at approx. 6 am. I did not sleep at all for the rest of the day.

The intent was to send me home on the Tuesday. However, I declined due to the unstable nature of my pain management. The staff nurse agreed to me being boarded for another day. I was also seen by a pain nurse to help me deal with the pain coming from my knee.

At approx. 03: 15 hrs on the Weds, I was awakened by a nurse to advise that they needed my bed and I was to be transferred to another ward. As they didn't have to correct type of wheelchair to support my leg, they fashioned one by putting a crutch under the cushion and me then sitting on it to provide stability.

I was moved to Ward 29 (Surgical) who were basically 'boarding' me due to the lack of available beds in Trauma. I was then 'forgotten' about as I had to chase the nurses on Ward 29 to see if I was going to be seen by an Ortho doctor and Physio in order that I could be sent home.

I did eventually see the Ortho doctor and Physio and was then discharged. The same problem re no wheelchairs with full leg support occurred again. I, therefore, made the sugestion of a crutch being put on the seat and a pillow to protect my posteria as there was no way that I could get from the ward to the front entrance on crutches - the distance is approx. 450 metres.

To say my experience was eventful and disheartening is an understatement. This is the first time I have had to use the NHS personally in 20 years and I am surprised at the lack of patient consideration and apathy that now exists within what was once a proud and exemplary service. Unless the patient is fully cognisant of there own circumstances and what is to happen they are at the mercy of others who are time and resource starved.

This is just the start of my journey to recovery and I really hope that things get better.

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Response from Lorna Gray, Patient Experience, Public Involvement Project Manager, NHS Greater Glasgow and Clyde

Good afternoon,

You have written in great detail about your recent experience, and your frustration at some of the aspects of your care is clear to see. I have spoken with some of the clinicians involved in your care in order to reflect on your experience.

I appreciate that the time between your injury and the date of operation will have felt like a long wait to you due to the change in hospitals. The delay to your operation from the Sunday to Monday was due to emergency surgeries which were life / limb threatening taking priority, and I believe you were kept up to date about this at the time. I can assure you that this delay will have had no impact on the outcome for yourself, and similarly ERI were also content to discharge you for your operation to be undertaken on a semi-elective basis closer to home.

With regards to your pain relief during the night after surgery, I am sorry that this was not given to you more efficiently – I have shared this with the staff team so that we can look at how we manage this more effectively. I am glad however that the team arranged for you to see the pain nurse later that day to help you manage the pain from your knee.

As you mentioned, unfortunately it was necessary to move you after your surgery to the Surgical Ward 29. This is sometimes necessary due to bed pressures and is only done in consultation with clinical staff who identify which patients can be safely moved to other wards.

Overall, I am very sorry that you were left feeling disheartened by your time in the RAH, as this is not how we would wish any patient to feel on leaving our care. I understand that you have been back at the hospital for follow up and have also spoken with your Consultant subseqently as she was the On Call Consultant, operating on trauma cases at the time of your return appointment to the fracture clinic. I would encourage you to raise any issues you have with your medical or nursing team in the first instance, as this helps us to put things right for you at the time so as to avoid you feeling let down in any way once you have left hospital. As you say, this is the start of your journey and so I hope that your experiences are more positive from now on, however if there is anything else that causes you concern, please do not hesitate to contact Lorna Gray directly on lorna.gray@ggc.scot.nhs.uk.

Yours Sincerely,

Rahul Shanker,

Clinical Services Manager, Orthopaedics

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