"Hospital discharge"

About: Royal Bournemouth General Hospital

My mother (aged 87) had a hip replacement opertaion in March 2015. The operation itself went well and the hospital staff were competent and helpful. The OT/PT signed her off as able to leave hopsital after watching her make the short walk from her bed to the loo with a zimmer frame. This of course bore no relation to the mobility she would need to be able to cope at home.

The problem came when mum was discharged. She couldn't get into a normal car and so we had to rely on hospital ambulance which was only available at the end of the day. mum waited in the discharge ward from 9am until 5pm and although she was warn and had cups of tea and lunch she was not encouraged to walk. The ambulance driver brough mum into the house in a wheelchair. It took 15 minutes and physical assistance from myself and the ambulance driver to move her from the whhelchair into her comfortable chair. They then left - and I was left with no instructions about what mum could and couldn't do, and no-one to ring for advice.

Mum is a determined person and so she and I between us got her to the loo and into bed. We luckily had a commode in the house and I made that accessible for her in the nigh.

In the morning I rang the ward, apoke to the PT who said she was mobile enough to be discharged and this was not their problem.

They had no advice to give. Eventually our excellent GP mobilised the help we needed and the following day the community health team swung into action. Mum needed blood-thinning injections every day and there was no discharge letter to the community nurse team - it was only my phone call that alerted them.

Oh and by the way the hospital thought mum was coming back to an empty house.

My concern was that mum's expensive and sucessful hip operation was jeopardised by the lack of communciation between the hospital and the community team. Wuthout mum's determination and my presence mum would have had a humilaiting night unable to get to the loo and then probably rehospitalisation.

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Response from Royal Bournemouth General Hospital

Dear Anonymous

I am sorry to hear that your mother’s post-operative discharge care was not what you had hoped for or expected.

It can be difficult to respond in detail about a patients treatment or discharge without their case notes, so if you would be happy to share these with us then please contact our Patient Advice and Liaison Service (PALs) on 01202 704886 or PALS@rbch.nhs.uk . This would allow us to review your mothers discharge and aftercare in more detail.

In the meantime you have raised a number of points about the discharge and aftercare process which I will raise with the various department managers for their feedback.

I would be grateful if you could allow me until the end of next week to come back to you with a further response once I have heard from them.

Once again I apologise for the experience you and your mother had during her hip replacement in March of this year.

Regards Sue Mellor Head of Patient Engagement

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Response from Sue Mellor, Patient Experience Lead, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust

Dear Anonymous

Thank you for your patience while I was waiting to receive information back from the department managers. Once again we are sorry to hear that you were not fully satisfied with the care your mother received from the hospital, and hope she is recovering well at this stage, further on in her rehabilitation.

In response to your concerns, and as part of our strict discharge criteria, all of our patients should be assessed by both Occupational therapists and Physiotherapists, and not discharged until fully mobile and able to manage at home, taking into consideration all aspects of the patients’ home situation and available equipment. It appears from your comments that this did not happen and obviously fell short of our quality standard in this instance. For that we apologise.

Your mother should have received an occupational therapy assessment post–surgery and her needs assessed. Patients listed for surgery would also have a pre-operative home visitation in addition, although on rare occasions this may not happen if the patient is a late addition to the surgical list.

It is unclear why she could not have been taken home in a normal car as our routine hip replacements are able to travel in standard cars, however if your mother was in the discharge lounge for a long period of time she may have become very stiff and this would have affected her mobility.

Regular mobilisation post operation is highlighted at various points throughout, starting with pre-op education classes which all patients are invited to attend, on the ward once surgery has taken place and also in the patient education booklet which is given to every patient at their pre-assessment appointment and I apologise if this mobilisation was not continued during your mother’s wait in the discharge lounge. This learning need has now been addressed and the discharge lounge staff are aware of the importance of mobilising patients

You mentioned that your mother needed blood thinning injections every day and as such self-injection are practised with the nursing staff prior to discharge or arranged by the district nursing team. All patients have a discharge letter sent to their GP so I can only assume this was received after you made contact with them about your mothers discharge. You also referred to the physiotherapist you spoke with as being dismissive and unable to offer helpful advice; this attitude is unacceptable and will be raised with their manager.

I thank you for your comments and hope that we have been able to respond accordingly to your concerns. However if you wish to discuss any of your concerns further then we can arrange this with the Ward Sister, Head of Nursing or PALS team


Sue Mellor

Head of Patient Engagement

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