"Medical Admissions RD&E hospital"

About: Royal Devon & Exeter Hospital (Wonford)

(as the patient),

I was called by a GP and told to go to the triage unit at the RD&E with an overnight bag on a Saturday evening after some worrying blood test results.

The nurses in the initial triage section were rushed off their feet but very kind. Teresa, the nurse in charge, was excellent. Lots of 'Hello my name is'. They are clearly very aware of the 4 hour target for moving people out of this ward. I was fitted with a canula very painlessly and had an ECG and loads of obs.

When my painkillers wore off I asked for the Ok to take a couple of paracetamol. There was quite a delay before I got permission after a brief chat with a Dr and the pain got quite bad. Other than this I didn't have any contact with a Dr in the 4 hours I was on this ward.

What needs to be improved here is communication. What was I lying around waiting for- to see a Dr? For a bed? For blood test results? What would happen to me? Who would decide? How ill was I? When I managed to grab one of the staff flying hither and thither they could tell me nothing.

Once the 4 hours were up a nurse I hadn't seen before came and wheeled my bed down onto the AMU ward. Luckily, because I had vomited I was in a side room on my own. It was 11pm by this time and I was very tired. I was seen by a junior Dr, Dr Dan who told me my notes from admission with all the obs etc had got lost. As far as I am aware they didn't find them again while I was there. He took my medical history then went away after saying he needed a urine sample. After waiting a bit longer I went out to the nurses' station and told them the Dr wanted a sample which they then arranged.

I asked if I could go to bed and was told that I could. I then had to ask for bedding - my bed just had a bottom sheet. A nurse dumped a sheet and blanket on the bed and left so my husband and I made the bed. I went out again and asked for permission to take my meds which I had bought in with me and then went to bed. I was woken in the night for obs and got up a few times to go to the loo. I was so lucky having a side room and I did get some sleep.

I was aware however of loud voices at night at the nurses' station. At one point when I went out to the loo they appeared to be having a staff meeting around the desk and were talking in normal tones which no apparent effort to whisper. I know that they had a difficult night. A sectioned patient kept leaving and having to be brought back. No psychiatric team was available till the morning - surely in a major hospital like this it should be a 24 hour service?

Early next morning I saw a consultant ( Dr James I think) together with Dr Dan and a third Dr. I was told that if I could keep some breakfast down I could go home and that I would be referred for an outpatients gastroscopy later. Nothing was going to stop me keeping some cornflakes down by this stage!

A different junior Dr then appeared and told me I needed a chest X-ray. This was the first I'd heard of this but I got dressed and set off for the X ray dept. I was seen quickly. I then asked at the nurses station whether I could go. They said they would check and a nurse appeared and removed my cannula. As he was walking away I called after him to ask if I could go and he said yes. I rang my husband to come and collect me and packed my bag. I set off for the main entrance. I called ' good bye and thank you' to the staff at the nurses station as I left but no one responded.

Overall I would say that the triage team did ok under the circumstances but need to keep patients better informed.

On the medical admissions ward there was a serious lack of care, consideration and communication. Horrible!

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Update posted by HazelR (the patient)

I do feel sad that there has been no response to this story. Perhaps this standard of care is felt to be acceptable?

The promised referral for a gastroscopy never happened so my GP has now referred me.

Response from Caroline Lee, Partnership Officer, Healthwatch Devon

Dear Hazel,

If you would like further advice and information to help deal with this issue, please contact us on 0800 520 0640, email info@healthwatchdevon.co.uk or request a call back via our "Speak Out " webform on www.healthwatchdevon.co.uk. We are the consumer champion for Health and Social Care in Devon, and we are here to make sure you get your voice heard.

Yours sincerely

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Update posted by HazelR (the patient)

Thank you Caroline but I don't feel up to pursuing anything formally. I'm still rather unwell and awaiting tests and hopefully a diagnosis.

I just want the hospital staff to take on board what it feels like from a patient's perspective.

Response from Brenda Leaman, Patient Experience Lead, Royal Devon and Exeter NHS Foundation Trust

Thank you for taking the time to comment on your recent experience at the RD&E Medical Admissions Unit. Firstly may I apologise sincerely for the delay in our response. We will review our systems in the Medical Division in order to ensure that we meet our high standards in reviewing, learning from and responding to feedback about our service.

I am sorry to hear that your experience did not meet the high standard that we strive to achieve. I would be very happy to look into the specific details of your concerns and investigate this matter fully. If you would like me to do so, please contact our Patient Experience and Engagement Service. In the meantime, I will try to address each of your points generally.

I recognise that you felt that your care was “okay” in the triage area, however from your experience I believe that we have a number of issues to review and address. We strive to ensure that all patients are cared for and communicated with effectively. Whilst the Medical Triage Unit is very busy and we have recently experienced days of unprecedented demand, we strive to ensure that our patients have adequate pain relief and are fully involved in the plan for the next stage of their care. I am sorry to hear that you experienced a delay in the administration of pain relief and that you did not feel that the team had communicated the plan for your care with you. I will raise this matter with the Clinical Lead and Senior Nurse for the Medical Triage Unit to ensure that we monitor our systems for effective care, particularly during the busiest times when this can be more challenging for our teams to deliver and assess whether there are opportunities to improve our response during busy periods

Thank you for sharing your experience of being on the Acute Medical Unit. Again this is a very busy area and as a Trust we have experienced a significant surge in admissions recently. However a busy department is not an excuse for a poor patient experience. It was disappointing to read of your experience and this does not meet our expectations of high standards of care. I would expect linen and bedding to be on your bed when you arrive and would have expected the team to ensure that you were comfortable and had all the information that you needed to feel confident in your care. I am sorry that this was not the case in your experience. I will raise this with the Senior Nurse for the Acute Medical Unit and we will share your experience with the team at their Governance Meeting, in order to learn from your experience and put in place measures to ensure that our processes are improved in the future.

Thank you for highlighting the point around psychiatric services. We have recently worked with our partners in Devon Partnership Trust and the Clinical Commissioning Group to secure extended support from the Psychiatric Liaison Service with a view to improving our care for patients with mental health needs.

We have been undertaking work to ensure that our staffing levels within the Medical Triage Unit and Acute Medical Unit are reviewed in the light of the increased demands on our service in order to maintain patient safety and quality of care.

I am sorry that I am unable to provide a more personal response without your details, however, if you would like to discuss this further please contact our Patient Engagement and Experience Department on 01392 402093.

Adel Jones

Divisional Director Medical Services

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Update posted by HazelR (the patient)

Thank you very much for this response I do appreciate it. I do think that you need to review staffing levels, particularly in the medical triage unit.

I am pleased to say that I have just had a really positive experience in the endoscopy ward at the hospital which seemed to me a model of good care and genuine kindness.