"Nonpatient centred care pathway"

My mother is in her late eighties and woke up one Friday in July with a hot painful swollen red right wrist ( right handed frail lady with early dementia, I am a POA). I phoned her GP who saw her, examined, did bloods and made recommendation for pain relief. Over the weekend she was very sleepy, no appetite ,vomiting and was in pain. On Monday morning I contacted the GP who was concerned about a septic arthritis and tried to arrange for her to see the orthopaedic on call doctor . She was informed that mum would need to seen in  the initial medical assessment unit first.

QEUH IAU had a rapid patient triage with an excellent triage nurse who could arrange the bloods and ECG but needed a junior doctor to arrange the all important x-ray. Bloods and ECG were done pretty quickly. After 4 hours the junior doctor had not seen her to order the x-ray, and the nurse asked one of them to come into the waiting room to see mum in her wheelchair and order the test, she then wheeled mum round to x-ray.

Volunteers kindly gave us both tea in the waiting room at IAU. After about 6 hours mum saw the IAU consultant who made a diagnosis of pseudogout and asked the on call orthopaedic surgeon to see her. He did not think that they would want to admit or aspirate the joint.  He thought  tablets would be the advice. The GP had tried to arrange this referral earlier that day.  This was a waste of IAU resource which is clearly over-stretched, in my opinion and did not put the patient at the centre of the care pathway.

During the  2 hours in the IAU ward waiting for the orthopaedic surgeon I noted banks of computer monitors and banks of junior doctors in front of them, spending more time with computer screens than patients. The bottle neck in IAU seemed to be seeing a doctor. By this time mum had been sitting in her wheelchair for 8 hours, in the same incontinence pad, we had very kindly been given  a sandwich and hot drink by support staff who were very considerate.

Mum was exhausted " this is the longest day of my life "and I decided to ask her named nurse for the tablets and to take her home.  I said to the IAU staff I was happy to speak to the orthopaedic surgeon later when they arrived at IAU, or bring mum back to a clinic. There was no contact from the orthopaedic on call doctor. 

The tablets gave her vomiting and diarrhoea, which complicated her ability to care for herself. At the end of July after me and my elderly frail father helping mum to dress/shower / help with meals etc since for several weeks I asked East Dunbartonshire Home Care for tuck in service and assistance with showering. Assessment was done mid August and care will start towards the end of  August, which I think is quite a lengthy wait for personal care. I contacted GP again at the end of July as her mobility was reducing again, and the tablets had caused side effects and was stopped. The GP saw her again and repeated bloods, arranged a rehab referral.

There have been aspects of this journey which have been excellent, for example GP practice . The QEUH IAU initial triage. All the clinicians we met were professional, helpful and kind. The support staff likewise, including volunteers. 

The care pathway of using IAU to see a suspected septic arthritis was non-patient centred. The GP has done the correct work up and management plan, and mum needed to access the orthopaedic on call doctor.  This doctor we were told was very busy in A+E, which I understand, and the new on call doctor starting at 8:00pm was to see mum first, but had not made it to IAU by 9:00pm. Because we had left without waiting for that doctor, due to mums discomfort, the request for a phone call was ignored.  Not very considerate to the patient.

Personally I would rather see a rheumatologist for gout/pseudogout. It does not need to be seen that day, and could be brought back to a hot clinic in 24/48 hours.  This system of forcing everything in to the same day is not working at QEUH as they do not appear to have enough doctors to see the patients, or the doctors are having to spend too long on non-patient contact activities taking them away from the patients.