"ED visit with our toddler"

About: Royal Devon & Exeter Hospital (Wonford)

Our 22 month old son had become very breathless at home, and having called 111, the operator decided he need to be seen by a paramedic and dialled 999. He was working very hard to breath, grunting when breathing out, and sucking in his chest and tummy with every breath. The male paramedic who attended was professional, calm and reassuring. Our son took to him, allowing him to examine his chest and conduct some tests. He was concerned about his breathing and called for an ambulance to pick us up. After a fraughtful first 15 mins in the ambulance, he calmed down and fell asleep sitting in my lap, and his breathing improved alot. He was not working as hard to breath and the grunting was intermittent. Once we arrived we were accompanied by the female paramedic and ambulance driver to the the majors dept. His handover was done by the paramedic to the nurse in private, which I found a little odd. When they returned, what I imagine was some sort of triage consisted of the nurse asking me to lift his top, after doing so she instructed us to sit in the minors waiting room. We sat in the minors waiting room for 90 mins before I finally became agitated after a boy, aged approx 8, who had also been brought in by ambulance after our arrival, with a laceration to his face, was called through before us. I cannot understand why a child under 2, with respiratory problems can be left for 90 mins with no observations. When I questioned a nurse as to why we had waited so long, and why a boy with a laceration to his face was seen before toddler with breathing difficulties, I got told 'different people need to be seen by different specialities'. Then I got told 'he was next to be seen'. The minors waiting room itself was dirty with dried blood on the floor. This is a clear infection control risk. I cleaned the floor myself as I did not want my child to go on the dirty floor. And furthermore a consultant was giving a patient his confidential results in the waiting area for all to hear! This is completely unacceptable. The RDE also fail to have a separate waiting area for children in the dept, so our son was subjected to a number of different adult patients with 'special needs' who were alarming to be around. This waiting area was neither child friendly or safe to be in, with no toys for entertainment. Eventually a nurse came to do some obs in the waiting room as there were no 'paed cubicles' available. Surely if he can wait in an adult waiting room, he can use an adult cubicle? (Yes I could see a vacant cubicle.) By this point or son was tired, hungry and fed up and fought with the nurse the entire time. He made his presence known to the whole dept. After another 10 mins or so, we were shown to a paed cubicle which had not been cleaned thoroughly before we entered, most notable was a 'bung' from a cannula on the floor. The doctors exam was as successful as the obs. We were discharged with advice to return if his symptoms did.

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Response from Patient Engagement & Experience Administrator, Royal Devon and Exeter NHS Foundation Trust

Dear Anonymous

Thank you for sharing your story and I am very sorry to hear of the problems you experienced. I have forwarded your comments to the relevant department for a response. We would like to help resolve this for you and ask if you to call the Patient Engagement and Experience Team on 01392 402093 or 402071.

Kind regards


Response from Royal Devon and Exeter NHS Foundation Trust

Dear Anonymous

We were very sorry to hear that you did not have a positive experience of your recent attendance at the ED department at the RD&E. We have asked our Matron with a lead responsibility for Children to look into the issues that you have raised and I will respond to each in turn. However I understand that you have since contacted our PALS department and we will of course be responding to you in more detail following our full investigation.

You mentioned that you found the ambulance handover process taking place in a side room, away from your son and yourself seemed a little odd. We have the handover from ambulance to the triage nurse take place in a side room in order to maintain patient confidentiality. We would however have expected the triage nurse to greet you and your son, introduce themselves and explain that they were taking a handover in order to inform their triage. We would also expect the nurse to have explained the reason for the examination of your son's chest by lifting his top. Our Matron has stated that lifting your son's top to examine his breathing would be appropriate triage, however she would expect the nurse to fully explain what they were doing to you. We are very sorry that this was not the case and our Matron assures me that she will ensure that this is communicated to the team in order to improve our care in the future.

On completion of triage patients are then directed to specific areas within the department. We do have a Paediatric Assessment Unit that is open until from 9am until 10pm and many of our children are seen in this area, which is specifically designed to meet the needs of children. This area is close to the main Emergency Department. We do also have a separate Children's Waiting Area within the main Emergency Department. Again we would expect that this should have been signposted to you by the nursing staff and apologise that this was not the case. Your feedback has also highlighted to me the fact that signage of the children's waiting area within the Emergency Department needs to be improved and I have been informed that new signage has now been ordered to improve the experience of patients with children. We absolutely agree that children should be looked after in an area suitable for their needs and we are working hard to ensure that we have the right play equipment to help soothe children and their parents whilst waiting for treatment.

You outlined in your feedback that there was a long wait for your son of 90 minutes without having observations. We absolutely agree that this is not acceptable. Our Matron will be very happy to look into the specifics of your son's case should you wish her to do so in order for us to gain the maximum learning from your experience.

There are many different teams that work within the Emergency Department and depending on the availability of those teams, some patients who have waited for less time seem to get seen first. This can be the case where patients with minor lacerations can be dealt with by a nurse practitioner, who can often see patients more quickly. I am really sorry that this was not fully explained to you and that you had a longer wait than we would have wanted you to have. We will reiterate to our team the importance of good communication with our patients.

I was very disappointed to hear that the floor in the cubicle was dirty. This is unacceptable. Our Matron assures me that she will communicate to staff the need to maintain cleanliness at all times. She encourages members of the public to make concerns known to the nursing staff should they witness any areas where cleanliness does not meet the high standard we should expect and that these will be received and acted upon swiftly. However I have asked her to look into this issue with the team to identify any further actions that need to be undertaken.

Thank you for your feedback, every patient is important to us and we strive to deliver the highest quality of service that we can. We have taken the opportunity to learn from your experience in order to improve our service in the future.

Divisional Business Manager (Medical Services)

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