Hospital receptionist sent patient away before appendix burst

NHS Lothian has been rapped by health watchdogs after a patient in pain was sent away from hospital by a receptionist – only for their appendix to burst later that night.

The Scottish Public Services Ombudsman (SPSO) has ordered the health board to apologise to the patient, who is only referred to as ‘A’ to protect their anonymity, after they presented at Western General Hospital’s medical assessment unit in pain.

Rather than be seen by a medical professional in person, the receptionist at the unit took details of the symptoms and told clinical staff about the symptoms.

The receptionist then sent the patient away to phone NHS 24.

The telephone service told the patient to take paracetamol for the pain, but in the early hours of the next day the patient was rushed to hospital and received emergency surgery for a burst appendix.

The patient’s relative, who is only referred to as ‘C’ in the ombudsman’s report, submitted a complaint to NHS Lothian, which brushed off the complaint and said the receptionist acted ‘in line with normal processes’.

However, the SPSO has now ordered NHS Lothian to apologise to both ‘A’ and ‘C’ – firstly for their initial mistake in turning away A, and in how they mishandled C’s complaint.

A report from the SPSO reads: “C complained that the board failed to appropriately triage their relative (A) when A self-presented to the Medical Assessment Unit (MAU) at Western General Hospital feeling unwell.

“A spoke with the receptionist who took details of their symptoms and, having discussed A’s symptoms with clinical staff, the receptionist advised A that they should contact NHS 24.

“A left the hospital and contacted NHS 24 who advised A to take paracetamol for the pain.

“A was taken to another hospital in the early hours of the next day and had an emergency operation for a ruptured appendix.

“In response to the complaint, the board explained that the receptionist acted in line with their normal processes.

“C was not satisfied with the response provided and brought the complaint to our office.

“We found that the board were unable to evidence that A was reviewed by a triage nurse or doctor in person as per their protocol.

“Given there was no evidence that the appropriate protocol was followed, we upheld the complaint. In addition, having reviewed the handling of C’s original complaint, we concluded that the board failed to appropriately investigate and respond to C’s complaint.”

The report orders NHS Lothian to “apologise to A for failing to follow the protocol when they attended the hospital and for failing to take appropriate records of the assessment and triage”, and to “apologise to C for failing to appropriately investigate and respond to their complaint”.

Dr Tracey Gillies, medical director at NHS Lothian said, “We accept the ombudsman’s recommendations in full and have already issued written apologies directly to A and C. I would also like to take the opportunity to apologise for the failings in this case and for any distress caused.

“Reception staff do not carry out medical screening or assessment of patients, but will gather initial information about patients such as their name, address and date of birth, and will find out what their symptoms are before the details are passed to our clinical teams.

“Patients will only be directed to the most appropriate service following input from our clinical teams.

“In response to this complaint, the service carried out a review of their processes and implemented some minor changes to support the triaging of patients.”

This marks the second time this month NHS Lothian has been ordered to apologise to a patient for problems with diagnostics and complaints handling.

Recently, NHS Lothian was forced to apologise to the parents of a disabled child after failing to diagnose the child’s hearing loss for nearly six years.

The SPSO investigated the health board after it received a complaint from the patient’s parents, who said NHS Lothian had failed to diagnose their child, despite numerous hearing tests between June 2012 and January 2018.

After repeated concerns were raised by the child’s parents and school, the patient was sent to another health board, where they were diagnosed with hearing loss. By that time, the child was eight-years-old.

Health chiefs were also rapped for their complaints handling procedures, with the SPSO saying their responses to the child’s parents “were very poor”.

By local democracy reporter Joseph Anderson