"Transfer following broken leg to surgery provider from Mull to Inverness"

Individually the care was provided, generally compassionately with attention to dignity. No one appeared to take a co-ordinated overview of the care experience, timings etc for transfer to meet ultimate care goal(s). Noting potential clinical window of opportunity limitations. Noting long duration of fasting and fluid restriction in hot weather conditions, lack of sleep, increasing patient worry as time progressed etc. Issues relating to toilet requirements were part created by transport delays – no alternatives or forward planning appeared to be considered. Transfer is all within a single health board area. Is this experience acceptable? I had no idea about background communications about transport although the staff seemed to know little more. What contributed to the delays and inefficiency? Staff are being creative but should they have to? Where is the governance?  

Incident: I was returning along the Lighthouse walking path when I slid on gravel, heard a snap and fell approx. 18:00.

As I was on the point of calling 999, a local resident passed, who raised the alarm. Coastguard arrived quickly. They carried me down the path for approx. 1 km to Tobermory to the waiting ambulance. The teams were very reassuring and reckoned I would be fine as going by prior experience I would likely be airlifted to hospital as it seemed likely surgery was a strong possibility but the doctor would know more. I am extremely grateful to the emergency responses teams. My husband remained in Tobermory.

I was taken to Mull community hospital. No radiology was available as it was after hours but the injury was assessed as probable spiral fracture tibia and fibula. A temporary back slab plaster was applied.

Airlift excluded as a disproportionate response by doctor, but a 12 to 24 hour clinical window should injury manipulation be required to minimise long term damage

Radiology in Oban but advised no ferry now and no radiology on the island on Fridays. Fastest/Usual route agreed to Oban then Paisley. I was told I could wait for land ambulance on the Friday to Oban but the doctor advised I could wait a long time, possibly all day. Advised it would be best for me to be discharged from the Community hospital in Mull with a referral to Lorne and Isles Hospital in Oban, make our own way by taxi to the ferry terminal, go over to Oban as foot passengers and get a taxi at Oban ferry terminal to Lorne and Islands Hospital for radiology. I contacted my husband to make taxi arrangements to catch earliest morning ferry at 07:10. Is this the type of care decision staff should be having to make as an optimal decision?

No overnight bed in hospital: no discharge to boat, no discharge to B&B as I was unaccompanied. Should staff have to be this creative? A bed was found.

The nursing staff very kindly made me toast and allowed me to drink something. After midnight fluid was to be sips only and I would be fasted again. I had not eaten since 13:00 hours or drunk fluids since 15:00 hours.

06:10 on the Friday first practice on elbow crutches getting to the taxi The ferry staff wheelchaired me on and off the ferry. The Oban ferry terminal phoned a taxi to the hospital. The terminal doors, Oban were very stiff. I was unstable on crutches and I fell through the door.

08.40 arrival at Oban hospital, no offers of assistance. Husband got wheelchair. Back slab removed, radiology, application of above knee back slab and further radiology took around 3 hours.  Paisley or Inverness offered for surgery as the road distance was similar so opted naturally for home.

11:40 advised a 4-hour road ambulance had been booked, although 4 hour could mean 6 hours but to be ready. Caused challenge for my husband obtaining food etc. No one advised he could have gone on ahead himself to Inverness. Waited in corridor with no updates.

Approx 16:30 hours I was moved to a ward bed, remaining fasting and fluid restricted to be ready for surgery. Was  window of opportunity still relevant? 17:40 I was advised unlikely I would get surgery that day I could eat and drink up until midnight. I fluid loaded to rehydrate and minimise the chance of a UTI. Advised not known if my husband would be able to go with me. Problematic as the last bus from Oban 16:00 hours. 

21:25 ambulance arrived and toiletting was rushed, medicated so ambulance would take me and hustled to transport. Crew did take my husband.  I needed to stop to urinate. There was only one slipper for journey. When I needed to urinate again, told I knew there were no more slippers, and surely I could hang on as it was only another hour. I would not last another hour and asked for an incontinence pad. I was soaking on arrival at Raigmore 01:30 on the Saturday. One paramedic advised staff I was desperate for the toilet. The other said ward staff would deal with that mess. The ward staff were waiting and wondered where we were. Despite toilet request, staff insisted on weighing me immediately. This ensured my  my dignity was compromised and staff seemed surprised on urine volume passed! Bed change and wash required!

After midnight so further fluid restriction and fasting (no food or fluid enroute). Theatre prep at around 06:00, taken at 12:30 and 13:30 for surgery.

Discharge noted CKD2, possibly the result of almost 2 days fluid restriction and fasting in hot weather?

I do understand remote and rural issues around the economics vs accessibility of services. I could only contribute to decisions on information at each point of care provision. I may not have been thinking well in distressed state.

Decision making-piece meal, transfers extended. Theme of lacking overarching joined up logistics is apparent. I hope changes could be implemented to prevent others going through inappropriately long transfers.