"Poor treatment at A & E"

About: North West Ambulance Service NHS Trust / Emergency ambulance Tameside General Hospital / Accident and emergency

(as a staff member posting for a patient/service user),

This story has been posted by Healthwatch Tameside on behalf of a member of the public who asked not to have their name published. They said…

83 year old lady fell at home. Severe pain in leg and large gash on calf, bleeding heavily. She lives alone, with no family apart from a niece who she couldn’t contact. Ambulance took a very long time to arrive, then waited outside A & E for 1 ½ hours before they wheeled her in. Then waited 6 more hours before she saw a triage nurse. The wound was sutured. No x-ray was ordered although her mobility was very poor. She had to go home by taxi, still in pain.

She was told district nurses would see her in 2 days, but they did not. She returned to A & E as wound still bleeding. Told it had been badly sutured, and had to be stitched again. Still no x-ray ordered and no doctor consulted. She has now been told she has a blood clot in the other leg, possibly sustained at the time of this injury. Her mobility is extremely poor. The district nurses have now received instruction to visit and dress wound, but had not done so at the time this information was provided.

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Response from Lindsay Stewart, Deputy Director of Nursing, Tameside and Glossop Integrated Care NHS Foundation Trust

Thank you for taking the time to post your comment on Healthwatch.

Your long wait to be seen when you finally did get into the A&E department would undoubtedly have been due to the department experiencing a very large surge in both walk in patients and ambulance arrivals. This does sometimes happen and it creates a very difficult environment for patients and their careers with long waiting times.

I can assure you however; that we do have a rigorous system in place that does ensure that those in need of immediate care and attention first get that care, so at no time is anyone in any danger. When a large ‘surge’ happens, it is inevitable that at least one, but more usually two – three patients are in need of high level intensive lifesaving treatment and this depletes the number of staff available to deal with those waiting. However, that does not detract from the fact that you did have a long wait and doubtless in some pain and distress. You do not mention this, but our standard procedure when there is a long queue is to offer those who are able tea and a sandwich. I hope this was offered to you?

If on examination, the leg wound showed no clinical signs of a fracture or other bony injury, then an X-ray would not have been ordered, but this should have been explained at the time.

I am sorry, but I cannot determine if a District Nurse referral was made subsequent to your first visit. This is standard and normal practice, so there was no reason it should not have been, but again, whatever the reason, apologies are offered.

On the second visit, being told the wound had been ‘badly sutured’ by a colleague is both inaccurate and unprofessional. There is no way of knowing what the condition of the wound was that prompted the first suturing technique, and I am both sorry and very displeased that you had to hear this inappropriate remark. Sometimes, after suturing, the injured part will swell further and put a strain on the existing sutures, The fact that the wound continued to bleed is not an indication of poor initial suturing, but could have been due to many other factors (e.g. the clotting ability of your blood at the time). The second person who saw you should have known this.

I hope very much that you are now in the care of the District Nursing team. If you have any queries, please do not hesitate to get in touch with Tim New as Manager for A&E

Kind regards

John Goodenough

Director of Nursing

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Response from North West Ambulance Service NHS Trust

Thank you for taking the time to provide feedback regarding our Paramedic Emergency Service via Healthwatch. I was sorry to read that the patient was unhappy with the level of service provided. North West Ambulance Service NHS Trust triages all emergency calls to ensure that those patients in the most immediately life threatening situation receive the fastest response. All calls to our Emergency Operations Centre are recorded and we would welcome the opportunity to investigate the concerns you have highlighted.

In order to undertake a full investigation we would require the date, address of the emergency, and the patient's consent. If you would like an investigation to be undertaken please email: patientexperience@nwas.nhs.uk or telephone: 0345 112 6500.

Thank you again for taking the time to bring this to our attention.