Ref 244/2006 (The 244th complaint ?)
Dear Mr Ackerley
I write in reply to your letter received on 12 September 2006 regarding your recent admission to ward K3. I am sorry to learn of your recent dissatisfaction with our service and in particular the overall care you received during your admission.
Mrs S Shannon, Assistant Director of Operations has asked Mrs D Stafford, Directorate Manager to investigate your concerns and the findings are incorporated in my response.
As you state in your letter you were was seen (
sic) in Dr Steiger’s (Consultant Neurologist) outpatient clinic on 22 August 2006. During this review you informed him you were having problems with frequency of passing urine and abnormal renal function. You explained to him that your GP had referred you to a nephrologist and you were waiting an out-patient review. Whilst you were in clinic, Dr Steiger discussed your situation with Dr Schultz (Consultant renal physician) who suggested that you be admitted that day to Acute Medical Unit (AMU) and that he would review you the following afternoon.
You were transferred to AMU and initially reviewed by a senior house officer and later reviewed by Dr Capewell, on-call Consultant Physician who in addition to the blood tests taken in clinic to assess your renal function, also recommended a 24 hour urine collection and an abdominal ultrasound. Dr Capewell’s further advice was that you should remain on AMU until Dr Schultz came to see you on 23 August.
On investigation, the ultrasound department have checked the paper request forms and identified that a request for abdominal ultrasound was written on 22 August, although it is not clear on which day the request reached the ultrasound department. Mrs S. Johnson (Radiology Manager) has reinforced to her staff the importance of recording the information on paper referrals onto the electronic system as soon as possible. Further education to all medical staff to use a more effective electronic requesting system for radiological tests is ongoing. Please accept our sincere apology for any distress and inconvenience caused to you by the delay in processing the ultrasound request.
The 24 hour urine collection was commenced whilst on AMU although needed to be restarted as the first collection was interrupted. This test was not re started. This is unacceptable and I am sorry that this did not happen. Please be assured that Matron Tunney (AMU) and Matron Wade (K3) have spoken with all of their staff about the importance of following medical recommendations for tests and ensuring that patients are kept informed of progress. The Matrons will continue to observe nursing practice on their wards through case note audits to ensure high standards are achieved and maintained.
It is recorded in your health record that you were reviewed on the 23 August by Dr Atherton, Consultant Physician and further blood tests were organised. Later that day, Dr Schultz reviewed you while on AMU. Some blood test results from the previous day were not yet completed as they are quite complex and take longer than one day to analyse. Dr Shultz made recommendations that an ultrasound scan was needed to check for the possibility of post renal obstruction (blockage in the urinary system external to the kidney) or hydronephrosis (enlarged kidneys). He understood that this scan had been requested on 22 August. Dr Schultz then suggested some options in the medical records for your care plans based upon the forthcoming results of your blood tests. The options were: if there was an improvement in your renal function, you could be discharged and be reviewed the following week in his outpatient clinic. If there was a deterioration in your renal functions then an urgent renal opinion could be obtained. Continued daily monitoring of your blood urea and electrolytes was also ordered and completed.
On 24 August, you were reviewed by Dr Chandy, Consultant Physician and transferred to Ward K3. He noted that you were not volume overloaded (a side effect of renal failure) agreed with the recommendation that an ultrasound scan of your kidneys needed to be performed, and that this should be doe as an in-patient.
As there had been no date received for your ultrasound, other than your previously arranged out-patient date for your scan on 6 October (
that my GP classed as urgent, and Whiston pencilled in for months later), a second request was sent to the ultrasound department and your scan was performed on 25 August. I understand that you have had a conversation with Mrs Shannon where you have described the radiology staff member who attended to you was unprofessional and unhelpful regarding the date of your scan. This information has been passed to Mrs Johnson and she will investigate which staff where on duty on this day and discuss with them that unprofessional behaviour is unacceptable and will not be tolerated.
Your next senior review was on 25 August on Ward K3 by Dr Alsharef (specialist registrar). Your ultrasound test results were noted as showing mild hydronephrosis of both kidneys. Again it was suggested in your medical records that if your renal function was improving over the weekend, you could be allowed home and be reviewed the following week by Dr Shultz in the outpatient clinic. I am sorry if any members of staff suggested you were able to be discharged sooner than your condition allowed. Matron Wade has discussed with staff the importance of correctly interpreting medical recommendations made in the case motes and ensuring that patients are also kept correctly informed.
Daily monitoring of your blood urea and electrolytes continued over the weekend as per medical request. On 28 August, the nursing documentation records a request by nursing staff to the junior doctors to review your blood pressure and increased creatinine levels. No alteration in treatment or tests was ordered. I am sorry that a more senior review did not happen at this time and that you were not given any advice on your diet and fluid intake. Matron Wade has identified that staff need education in the care of patients with renal disorders and will build this into the ongoing teaching that happens at weekly ward teaching sessions.
Your next senior review was on 30 August 2006 by the Dr Rayeram, the Senior House Officer (SHO) on the ward who commented that your kidney function had deteriorated over 24 hours but as you were due to be seen by Dr Schultz in the renal clinic the following day, (
held in another hospital), the SHO suggested that you should keep the appointment.
Dr Hammond, Consultant Cardiologist reviewed you on the morning of 31 August and noted that your kidney function had deteriorated and you were due to see Dr Schulz that afternoon. Dr Hammond recalls explaining to you that in view of your deteriorating kidney function you may be transferred to Royal Liverpool Hospital to be under the care of the kidney physicians.
Dr Schultz saw you in the clinic and noted the results of the tests that had been obtained.
He planned for your care to transfer to the Royal Liverpool Hospital where you would undergo a kidney biopsy. Whilst awaiting a bed to become available, he asked for an urgent urology opinion and continued monitoring of your blood urea and electrolytes. (
He also recommended a scan which was never done and would have saved a lot of time and pain. No mention in this in the apology!)
You were reviewed again by Dr Alsharef the following day, 1 September, and an urgent urology opinion was planned together with daily urea and electrolytes and a fluid balance chart of input and output, which was carried out. (
Nooo, I was left, forgotten for 4 days until I was transferred to the Royal).
I am sincerely sorry that you were dissatisfied with the treatment and care you received during your stay at Whiston Hospital. The quality of care you received was below the standard we strive to achieve and maintain to all our patients.
The Trust takes complaints very seriously (
translation: we are sick of people suing us ?) and I hope that the actions implemented assure you that we are committed to improve the care we provide to our patients. (
translation: please don’t sue!)
Once again, my sincere apologies for the distress you have experienced.
If you wish to discuss the response further or have any concerns, please do not hesitate to contact Mrs S S Shannon, Assistant Director of Operations on 0151 430 1317.
If after contacting Mrs Mrs Shannon to discuss the response you still remain dissatisfied then you should contact Mrs Carol Freeman, Complaints and Claims Manager on 0151 430 1434, quoting the reference number at the top of the letter, within 28 days, who will explain the available options to you under the NHS Complaints System. (
translation: Oh poo, you have a strong case. What’s it going to cost us this time!)
Comments: 25th May 2007
It is at this stage I point out a few facts the apology glossed over. Read the letter again to see if you catch the omission… Consultant Cardiologist, Registrar, SHO. Besides Dr Schultz from the Royal, no kidney doctors, and, more damningly, no Consultant Urologist. I have been assured that Whiston has an exceptional urology ward and teams – so why wasn’t I seen by any of them?
And why is this important? Well, I’ve just had it confirmed by a Consultant at Broadgreen hospital that the underlying cause may be due to thickening of the bladder wall (being looked into) – a urology condition.