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Discharge procedure from ED

Posted By Hip dis

"Discharge procedure from ED"

About: Royal Cornwall Hospital (Treliske) / Emergency Department Royal Cornwall Hospital (Treliske) / Trauma and orthopaedics South Western Ambulance Service NHS Foundation Trust / Emergency ambulance

(as the patient),

I recently fell at home, dislocating my replacement hip. The ambulance arrived immediately, ED was quiet and I was cared for very well. The closed reduction of the displacement was a success. 

However, I was discharged with no advice, no precautions, no exercises to follow. 

I did contact my GP the next day asking for advice but again, no precautions advised and physio appointment offered at the end of November! I felt elated about the success of the procedure to my hip but a month later it dislocated again. I was sitting in, what I now know, was a dangerous position for my condition.

Please advice ED about discharge advice when the patient has had a closed reduction.

I am so cross that I wasn’t advised of actions I should avoid and strengthening exercises I should do. 

My 2nd displacement happened at 3pm and the ambulance didn’t arrive until 9pm. I spent all that time in a sand pit, unable to move, outside. I then had to stay in the ambulance (not in ED) until 3am when the closed reduction was done in ED. I did enter ED for an x ray but was taken back to the ambulance.

I don’t consider that experience to be adequate or satisfactory. I am aware, from the press, of pressures on NHS. Once in ED /resus, I had to be moved into the corridor not long after my closed reduction. I stayed there until 3pm. Again, this is unsatisfactory. Just because these scenarios are common does not mean they are satisfactory. 

Care in ED once in the corridor was not good. Despite asking, nobody could tell me why I was there or what was going to happen. Eventually I was told to go home. Again no advice! By now I was cross and weepy. I insisted on speaking to either physio or orthopaedics before I left. A very professional, caring physio arrived who gave me clear advice and some exercises. Why did that take my tears? 

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Responses

Response from Robyn Jones, Sister, Emergency Department, Royal Cornwall Hospitals NHS Trust 9 months ago
We are preparing to make a change
Robyn Jones
Sister, Emergency Department,
Royal Cornwall Hospitals NHS Trust

I work in the Emergency Department as a Sister. I support a team of nurses and doctors in delivering emergency care. I co-manage performance and conduct with the ED senior team in line with local and national policies. I believe that maintaining contact post attendance with our services users is really beneficial. Gaining your valuable feedback can help us create changes so we can deliver the best service we can.

Submitted on 18/09/2024 at 12:00
Published on Care Opinion at 12:00

picture of Robyn Jones

Dear hipdis

I completely empathise and agree. You should not have had to be reduced to tears in order to get standard advice.

Firstly, I would like to apologise for the long wait for the ambulance and for treatment once in the department the second time you had to come into hospital. It is difficult to determine if any exercise advice or physio could have prevented a second dislocation. It is possible and I agree you should have been given advice at the time following the initial hip replacement and after the first dislocation.

I have had a look on our ED patient advice leaflets if we hold any post hip reduction advice but I cannot find anything. I will liaise with the senior medical team, orthopaedic and physio teams to instigate we obtain this advice for future patients.

I would also like to apologise for waiting in the corridor with little updates to your plan of care. The corridor is not a dignified place to be cared for. Unfortunately due to extreme pressures we have had to spill into this space to maximise our capacity and release ambulances into the community.

Secondly, I would like to thank you for your time in sending your feedback. I hope you are recovering well and the physio is helping.

If you have any other questions or feedback please do not hesitate to contact me.

Best wishes

Robyn Jones

ED, Sister

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Update posted by Hip dis (the patient)

Robyn thank you; your response is thorough and lets me see that you have read my comments carefully. I am very relieved to hear that you will now ensure that ED will be issued with post hip dislocation advice and precautions.

Response from Deanne Hill, Patient Engagement Manager, South Western Ambulance Service NHS Foundation Trust 9 months ago
Deanne Hill
Patient Engagement Manager,
South Western Ambulance Service NHS Foundation Trust

Submitted on 19/09/2024 at 17:27
Published on Care Opinion at 17:27

Dear Hipdis,

Firstly, I am sorry the experience you had with our service has been a negative one, we thank you for taking the time to send us your feedback as it helps us to develop our service for our patients who use it.

Secondly, unfortunately, any patient details are redacted on this platform for confidentiality and so we cannot find your incident. If you would like to progress this as a complaint, please could I ask you to forward your message and details to: patientexperience@swast.nhs.uk and a member of our team will be delighted to help you.

Thank you again for taking the time to share your experience with us and we do hope you are recovering well after the recent need to use our services.

Kindest regards,

Phil

Patient Engagement Team
SWAST

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