"My mother and her nosebleeds"

About: Ayr Hospital / Ear, Nose & Throat Crosshouse Hospital / Ear, Nose & Throat

(as a relative),

My mother is 86. For a good part of the last decade she has suffered frequent and unpredictable heavy nosebleeds. Although not pleasant for her or for us (myself and elderly father) to deal with, until this year it was a relatively manageable process. If an ambulance was required, we would be taken to A&E in Ayr, 10 minutes away. Sometimes a follow up visit to Crosshouse (20 miles away) would be necessitated. Again, not ideal but manageable and generally a one-off.

This year however, we have had to deal with an increasing frequency of bleeds and the added difficulty of compulsory attendance at ENT Crosshouse when an ambulance has had to be called. This raises a number of issues - the transportation of an 86 year old lady with the beginnings of Alzheimers and other health issues to what is to her a faraway location.

The process which starts in Crosshouse A&E and has to wait for the OK from ENT five floors above. A space-strapped ENT unit with a broom-cupboard sized waiting room and precious little else space. No offer of even water, regardless of the length of stay. No automatic offer of transportation back to Ayr (I don't drive, my father is 75 and can't cope with a drive out of town and two buses are out of the question for a frail 86 year old. )

On top of this the process is somewhat out of sorts. Every time this happens, on top of trying to staunch the bleed to avoid a hospital visit, or being transported to the most inconvenient place possible I end up having to tell my mother's life story, from beginning to end, in full to yet another paramedic/nurse/doctor/consultant/call handler....if a GP can read notes off a screen, why in this day and age is it not possible for other medical professionals in the same geographical area to be party to the same information?

Please understand I do not intend this as a criticism of the professional, skilled and caring staff that we encounter at every step of the process. In my opinion the process itself stinks. In an information driven society, why do I have to pass on the same information multiple times to different people who process it differently? Why occasionally does communication break down to the point we were forgotten about in Crosshouse A&E on a Sunday after specifically being transported to be seen at ENT? Why is there no consistency of treatment? A doctor with a camera one day, a nurse cauterising hopefully another.

I fortunately have been available to accompany her to Crosshouse every time in the last three months. I work, and it follows I will not always be available. I shudder to think how my parents will navigate this system by themselves - my father doesn't keep the best of health himself, his first language isn't English and has difficulty making himself understood. Left to cope in a large unfamiliar hospital will add to the problems at hand.

To give an example, on the last two visits I had to take Mum from the ward myself at the end of treatment. This is fine for a reasonably robust 49 year old who can push a heavy wheelchair through corridors and lifts and navigate the signage. My father, his hernia, and his limited grasp of English certainly wouldn't cope! I do appreciate that there is only a limited amount of treatment available in regard to my mother's nosebleeds - what I don't understand is why this has to be compounded with an unwieldy process that is in my view punitive and totally unsuitable for an elderly person who lives remotely.

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Responses

Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran

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Dear Pass The Gin,

I am so sorry that you and your Mum have had a poor experience. It is also such a shame you both have so much going on. I can provide an explanation to some of this for you and a solution to some of it too.

Outpatient appointments are available at Crosshouse and Ayr and we can explore what can be done to ensure your Mum is seen at Ayr as an outpatient, particularly for follow-up from emergency admissions In relation to emergency treatment, the Head and Neck receiving area is in ward 5A at University Hospital Crosshouse and this ensures that people with most appropriate skills and experience can treat conditions such as your Mum’s. While this is possibly more upsetting, more upheaval, and not ideal, it is preferable for your Mum to get the treatment she needs in 5A by the people with that specialty. Regarding the information sharing, our Nurse Consultant for Unscheduled Care, Paula Madigan, would be happy to have a chat to help facilitate an anticipatory care plan (ACP). This is a plan that could help circumvent all of the unnecessary parts of the journey whilst transferring key information. This plan would be agreed with your Mum GP and ENT Consultant so there is a clear and direct plan in the event this happens again. It will also contain key medical information and other helpful information pertinent to her care. The information in the ACP can be shared appropriately with those responsible for your care. This should help address most of the points you raised in your post. We are also in the process of rolling out the ‘Clinical Portal’. This is another way for clinicians to access important, relevant information about their patients in an electronic format. We have identified that our ENT colleagues are due to be trained and able to access this very shortly and this will help too. I am sorry to you had transport related issue upon discharge. Both the Ambulance Service and Red Cross provide support in terms of getting people home, particularly those with limited alternative options. If a patient is likely to have transport issues we would advise that this should be raised as early as possible upon admission so we can address this where possible. It is surprising to hear that there was no offer of water unless it is envisaged that an operation is required, which is very much standard practice. With details, we can look into this for you.

I would like to thank you for raising your concerns and giving us the opportunity to review things. I do hope this is satisfactory to you and that things get easier for you both. I am sorry this is so long but I was keen to address all your issues.

If you wish us to look into any or all of the points above, we will need additional information. If you would like us to do so, please contact me on - 01563 826222 or eunice.goodwin@aapct.scot.nhs.uk.

Best wishes,

Eunice

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Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran

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Dear Pass The Gin,

The Charge Nurse for ward 5A would like to add -

"On general introductions if the patient’s condition allowed we would offer water but if the they may require theatre or if the bleeding is significant – drinking water becomes difficult and it can cause choking.

We have looked at direct admission to the ward but this has been felt to carry various clinical risks. Therefore, admission via A/E reduces risk. It allows the individual to be registered on our electronic system, thereby allowing medication prescribing and also gives the opportunity for unstable patients to be seen in a department with appropriate staff. However, having said this, we acknowledge we can make small improvements and I will feed this back to the staff.

Charge Nurse, Ward 5A

University Hospital Crosshouse"

Once again, thank you for raising this with us, we are always keen to improve our service and your post will help s to do that.

Kind regards,

Eunice.

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Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran We have made a change

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A wee update

Dear Pass The Gin,

Thank you for contacting us off-line. As you are aware, we have had a few conversations with you and members of the team.

Paula has contacted our Integrated Care and Enablement Service (ICES) to arrange support in the home and a care plan is being drawn up as we speak. This will be shared with Scottish Ambulance Service, GP practice and the Community Nursing team and will help to keep your Mum in the comfort of her own home during such episodes and prevent an unnecessary hospital admission.

The ward is now looking at increasing awareness and education for patients and relatives for appropriate situations which will help others to mange their condition too. You will receive this help and guidance today.

I am so sorry for all the distress which led you to post your story, but I think it has resulted in some very positive outcomes and I thank you for raising the issues with us.

Best wishes,

Eunice

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