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Case ref:201801391
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Date:June 2019
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Body:Lothian NHS Board - Acute Division
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Sector:Health
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Outcome:Upheld, recommendations
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Subject:clinical treatment / diagnosis
Summary
Mr C complained about the care and treatment he received at the Royal Infirmary of Edinburgh. He attended A&E after experiencing pain in his back and leg. Mr C was assessed by the on-call orthopaedic (conditions involving the muscoskeletal system) doctor and an x-ray was performed. Following this, Mr C was admitted to an orthopaedic ward. He was then discharged four days following admission. Weeks later, Mr C returned to hospital and a hip x-ray was performed. Investigations over the following days identified that Mr C had a pathological hip fracture and advanced prostate cancer. Mr C underwent a hip replacement procedure and was referred to the uro-oncology (the diagnosis and treatments of tumors of urinary systems) service.
Mr C complained about the delay in accurately diagnosing his condition and that he was unreasonably discharged from hospital during the first admission. We took independent advice from a consultant orthopaedic surgeon. We were critical that the board were unable to provide the in-patient orthopaedic notes for Mr C's first admission, other than the summary of ward rounds.
We found that the investigations performed following Mr C's initial presentation to the board were inadequate. We found that a hip examination and hip x-ray should have been performed given the examination findings. We considered it was likely that the failings in this case led to a delay for hip replacement surgery, during which time Mr C continued to suffer pain from the condition. We upheld this aspect of Mr C's complaint.
In the absence of the orthopaedic records for the first in-patient admission, we noted that the board were unable to demonstrate that Mr C had been safely discharged. We concluded that the decision to discharge Mr C was unreasonable and we upheld this complaint.
Recommendations
What we asked the organisation to do in this case:
- Apologise to Mr C for the failure to examine and investigate Mr C's hip during the admission and for the poor record-keeping. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.
What we said should change to put things right in future:
- An individual with thigh pain and an inability to weight bear should have a hip examination performed. An individual who is unable to do an active straight leg raise and is unable to weight bear should have a hip x-ray performed.
- Ensure clinical records are appropriately managed.