"Inter department communication not good"

About: University College Hospital

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Via Rheumatology I have been a patient of the physiotherapy dept to help me with the problems with hypermobility and my gait. I saw a physio on 16 Oct 2012 following a referral from Rheumatology. I had bruising and discolourisation to my right foot and was complaining of issues with my lower back on the right side and weakness into the right leg and foot. The physio offered me as a solution a pilates physio class to stabilize the low back and told me to go an have an x ray in A & E. I had the X Ray and the results said burstitis in the metatarcels of the right foot and advised me to get re referred to Rheumatology. The date for the low back stability class to commence on 26 Nov 2012 4.30 – 5.30 for 8 weeks. I had seen the Rheumatologist on the 19 November and was told that I needed to have treatment to the right foot.

At the first class I told the physio about the foot and during the class I experienced the problem with the right side from the pelvis to the foot. . After the class I went home. I had problems all week including numbness etc. Arrived early back at the class 3rd Dec and explained the situation to the physio. He told me to see my GP. The problems in the class were really extreme – I had spasms in the muscles of my leg and under the foot. After the leaving the class I walked for about 5 minutes and catapulted off my foot, slammed on to the pavement and a passer by dialled 999 for an ambulance. A paramedic arrived on a bicycle. I ended up in A & E at UCLH. They X rayed the foot to check it was not broken, gave me crutches and told me to take pain relief. Unfortunately the ferule on the bottom of the crutches was very spongy and it slipped all over the pavement and I went over on the ankle again on the way home. I need to walk to the tube station as I did not have enough money for emergencies – I have a travel pass.

I rolled over again from the crutches that night at home. The foot was huge in the morning and exceedingly painful. NHS 111 service sent me an ambulance and I ended up at Charing Cross Hospital for another X Ray. After leaving Charing Cross I went over again on the way home. I called NHS Direct for advice and they sent an ambulance which took me back to UCLH. I asked UCLH for an air boot and they refused. The nurse said she would put me in plaster but asked me who would remove it. She said I was not a fracture clinic patient and I would not get an appointment to have it taken off. I did not have the plaster put on after hearing that.

The underlying long standing condition with the foot and leg reached crisis level in the physio clinic. There is no safety net to stop a patient ending up leaving the clinic and becoming an expensive accident emergency patient. I should have been given crutches by the physio dept after the class to enable me to get home safely and visit my GP as he requested.

There should be better communication between A & E and the other depts.

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Response from University College Hospital

Thank you for taking the time to raise you concerns regarding your treatment in the Emergency Department. I am sorry that you were unhappy with the care that you received when you attended. We are always looking for ways to improve our communication with other departments and with our patients. I will raise this case with the nursing staff and with the therapies department. Should you wish to discuss it further please don't hesitate to get in touch with me.

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