"Feedback regarding a recent admission to the RD&E"

About: Royal Devon & Exeter Hospital (Wonford) / Accident and emergency Royal Devon & Exeter Hospital (Wonford) / Trauma and orthopaedics

(as a relative),

My elderly father was admitted to the RD&E, Durbin Ward about three weeks ago. He had been referred for an MRI scan. The scan revealed the need for an urgent response and my father was speedily booked in for admission via the Emergency Department.

The outstandingly good thing is that both the Spinal Specialist Consultant and the SHO went out of their way to explain what was happening and what the options were. Both my father and closest family were involved. The SHO even took the time and trouble to ring me and my mother to keep us updated and talk through any concerns we had. She also took the time and trouble to have a very caring and sensitive conversation with my father to talk about the really difficult issue of 'do not resuscitate'. She has now arranged for my father to receive care in a community hospital closer to his home, which means my mother can visit him more easily. The ward staff on Durbin ward were also very approachable and helpful.

There were also some areas which could have been better whilst acknowledging that staff are working under severe pressures of demand and finite resources:

1) MRI scan - my father's problem was a spinal one and he found being asked to lie still on his back for approx. 30 mins excruciating; the confined space was also distressing to him. He banged on the scanner and shouted for it to stop because he was in such pain, but his cries for help were ignored and staff continued with the scan. They then 'blamed' him for not keeping sufficiently still to get a clear image. He came out of the scanner a very traumatised person begging for the scan not to be repeated. Bearing in mind that my father's spinal condition was so serious he was considered an emergency admission it seems obvious to me that careful thought should have been given as to how the scan could be done whilst keeping my father comfortable and calm.

2) Giving a diagnosis - I realise that the options for privacy and dignity are very limited in a busy acute setting. My father was given a diagnosis of potential paralysis and advanced cancer in a public place. In order to afford some privacy he was taken into a changing cubicle with just a curtain dividing him from the patients awaiting their scan appointments who were clearly able to overhear every word.

3) Missing property - in the space of two days two pairs of my father's glasses went missing from the tray by his bed.

Overall, I'm really grateful for the care that my father received at the RD&E.

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Response from Rebecca McGuffog, Patient Engagement and Experience Officer, Royal Devon and Exeter NHS Foundation Trust

Thank you for your positive feedback on the care your father received from our Emergency Department, spinal team and the staff on Durbin ward which we will share with them.

In response to your specific feedback:

1. We are sorry that the experience of the scan was so distressing for your father. Unfortunately it is necessary for the patient to lie on their back for an MRI scan of the spine as the piece of equipment which makes the image is underneath them. The scan process is slow, taking on average the 30 minutes described for the scan, and the images will regrettably be degraded by movement. Your father should have been made as comfortable as possible on entry to the scanner and would have been given an emergency buzzer to press if he needed to stop and ear defenders to reduce the noise. The scanner makes considerable noise whilst in operation and the staff would not have been able to hear your father if he tried to speak to them. Staff should have been making contact with your father between the scans to reassure him. The buzzer sounds an alarm to the staff operating the machine so that they can stop the scan and attend to the patient in an emergency. If the patient is in pain or known to be claustrophobic the doctors referring the patient can arrange for adequate pain relief and possibly sedation to make the process tolerable. It appears that the scan was requested as an emergency and possibly there was not time to arrange this. The staff will always stop a scan when they are alerted to a patient's discomfort, and it is regrettable that this did not happen more quickly on this occasion

2. We are very sorry to hear that your father was given such distressing news in a public area. As you say, providing privacy in a busy acute setting can be difficult, but nonetheless this is certainly not the standard we aspire to. If you contact the PALS office on (01392) 402093 with your father's details we would be very happy to investigate this further in order to ensure that other patients do not have this experience.

3. We are also sorry to hear that your father lost his glasses whilst on Durbin. We are unable to take responsibility for patients' belongings but are sorry for the distress this will have caused your father. Again, If you would like to contact the PALS team with your father’s details we will be happy to carry out a search for his glasses.

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Update posted by sheets of linen (a relative)

Thank you for your response, it's much appreciated.

1) The explanation regarding the MRI scan is helpful. However the scan was a prebooked referral from the GP so there should have been time to ensure that the good practice procedure you describe above was followed. It became an emergency when they analysed the results and realised the extent of the damage.

2) There is little point in contacting PALS regarding the privacy issue as I've given you all the information above. I certainly do not blame the clinician giving the information as they were under huge pressure and there was nowhere else immediately available to have this conversation. I make it as a general learning point that could be generally improved upon and so that you can review your policy for good practice in giving bad news.

3) With regard to my father's missing two pairs of glasses. The ward were informed at the time and did a search of the immediate bed area, as well as putting in a request to the laundry. So they did what they could. So again, no point in contacting PALS. I absolutely understand that the hospital can't take responsibility for people's belongings but glasses are an important item in helping people to stay connected when all about them is unfamiliar.

Response from Peter Brain, Volunteer, Healthwatch Devon

Dear 'sheets of linen'

The comments and responses on the web-site of Patient Opinion are shared with us at Healthwatch.

Thank you for responding in detail to the experiences of your father and yourself.

At Healthwatch we are building a picture of the provision of services in Devon and these comments should help the NHS and other providers develop and improve their services.

If you wish to discuss this or any health or social care issue with us in confidence, including seeking advice or information about services, please call 0800 520 0640, or email info@healthwatchdevon.co.uk or go on-line to www.healthwatchdevon.co.uk.

Yours sincerely

Peter Brain

Healthwatch Devon is the consumer champion for Health and Social Care in Devon.

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