"Rapid diagnosis missed despite us doing all the correct things"
Posted by Appalled and Frustrated (as ),
We presented at A& E at 9pm on a Thursday evening with my 68 year old father who was experiencing chest pain which had radiated centrally from front to back and down his left arm. We told reception he was presenting with symptoms of a heart attack and that there was a family history of heart attack despite my father being in excellent health and having zero symptoms until that day. We were told there was a 5h wait which then increased to 7h for major injuries while we were there.
We were seen within an hour for triage, bp check, ecg and blood tests which were sent away to the labs for processing and which should have been back within around an hour. When blood was taken I pointed out that his blood was slow flowing as my dad has given blood all his life and the tubes were filling very slowly - again unusual for him if any bloods have been required on previous occasions. We then returned to the waiting area.
When 2 hours after the bloods been taken had passed I enquired if the labs had come back, reminding them that they had been taken as he’d presented with cardiac symptoms. I was told they were very busy (the waiting room was relatively quiet but a couple of ambulances had come in) and that the wait was up to 7h - I asked even in cardic cases (one of the checklist of issues on a big sign in a and e that you should present to a and e with )? After another hour 4h post arrival and 3h post bloods my mum asked what was happening and when would they been seen. Again there’s a 7h wait.
At the 5h mark - now 2 am my dad enquired. Eventually after 3am - 6hours after we arrived we were called through to be told that potentially my dad had had a heart attack as his troponin levels were increased - confirmation of which required repeat blood tests after a 3h interval - this was now over 5h since the initial bloods had been taken. Dad was then admitted and bloods were retaken which subsequently coagulated so could not have been tested. Blood was then taken on the ward around 7 am to check the levels of troponin and at 8. 30am it was confirmed through the increased troponin levels that indeed as we had suspected and communicated clearly 12h previously that dad had had a heart attack. He was then given an injection to effect this.
Care on the emergency care ward and ward 4 was excellent. Dad was then taken for angiogram at hairmyres 4 days after presenting at a& e and had damage to a minor artery which required to be stented. Again the care at hairmyres and the surgical / consultancy team was excellent. The wait and delays in a and e I strongly feel could have contributed to the damage. I feel aspirin or anti coagulants should perhaps have been given at triage as a precaution. Opportunities have been missed for a rapid diagnosis despite us doing all the correct things - presenting at a and e, communicating clearly the issue and following up with the staff at reception repeatedly throughout the night.