Patient with perforated bowel suffered diagnosis delay after junior doctor missed 'red flags' in A&E

A patient suffering from a perforated bowel had their diagnosis delayed after a junior doctor missed “red flags” during an assessment in A&E.

After arriving at the emergency department of an NHS Forth Valley hospital, the patient was initially assessed by a junior doctor who ordered various tests and investigations.

They were later moved to the acute assessment unit and diagnosed with a perforated bowel The patient developed sepsis after undergoing emergency surgery.

The patient’s child complained to the Scottish Public Services Ombudsman (SPSO) about their parent’s treatment.

Specifically, they complained about the delay in identifying their parent’s condition, which they believe led to a worse outcome.

NHS Forth Valley acknowledged that a more senior doctor may have identified the cause quicker, but that the care provided was reasonable, and that the complaint had led to learning and ongoing development.

In putting together their report, the SPSO took independent advice from an emergency medicine consultant.

It found that there were “a number of red flags” when the patient was admitted and that it did “not appear” they had been reviewed by a senior clinician.

Issues were also found in the patient’s documentation; no intimate examination was recorded, and there was a “lack” of documentation around the interpretation of an X-ray.

Overall, the report concluded that the initial assessment delayed diagnosis of the perforated bowel and was likely to have had a “significant effect” on the patient’s outcome.

The watchdog made a number of recommendations for the health board, including apologising to the patient’s child.

It also advised that patients receive “appropriate treatment including assessment” in line with their symptoms, and that case records include any tests carried out and the decisions behind them.

A spokesperson for NHS Forth Valley said: “We have apologised to the patient for the failures in the care and treatment provided and have already taken action to address the recommendations in the report.

“This has resulted in learning and improvements to help prevent similar issues from occurring in the future.”