Apology after delay in heart failure patient’s diagnosis
NHS Fife has apologised for delays in a patient’s diagnosis of heart failure ahead of their death.
A complaint was made to the Scottish Public Services Ombudsman (SPSO) about the care of the person, named as A, who had originally gone to their GP about symptoms of a productive cough, breathlessness and occasional wheeze.
They were referred to the hospital and received two outpatients chest x-rays.
A had also gone to A&E and self-presented when they were discharged with a trial of steroids and an inhaler.
The SPSO report said that the first of the chest x-rays was reported as normal and the patient was routinely referred to the respiratory department for further investigation.
The second of the two outpatient chest x-rays was considered to show changes suggestive of pulmonary oedema a condition in which too much fluid accumulates in the lungs, interfering with a person’s ability to breathe normally.
At this point, A’s GP upgraded the respiratory referral to urgent. On vetting by a respiratory consultant, A’s GP was contacted with advice to commence a diuretic (drugs that enable the body to get rid of excess fluids) straight away and urgently referred A to cardiology, on suspicion of heart failure.
They were seen at the cardiac function clinic, with the plan being made to see them at the heart failure clinic. A’s condition deteriorated before being seen at the heart failure clinic and the GP arranged for their immediate admission to the coronary care unit (CCU).
The patient suffered a cardiac arrest shortly after admission requiring resuscitation, and they were subsequently transferred to another health board for surgery where they died.
The patient’s parent, known as C, complained about the delays by the board to assess, diagnose and treat A’s condition, especially as A had presented to the A&E, and after the follow-up x-ray showed significant deterioration within a four-week period.
Having been referred to cardiology, C complained that the board failed to treat A’s condition with the urgency it required.
Upholding the complaint, the ombudsman said that when examining the case, they found the first of the outpatient chest x-rays which had been reported as normal was in fact abnormal and required clinical correlation in respect of A’s presenting symptoms.
“Had this happened, a cardiac cause for A’s symptoms could potentially have been made sooner,” they stated. “With regards to the second chest x-ray, we found that the board failed to use the radiology alert system in place to flag urgent and/or unexpected findings.
“We also found that the vetting process by the respiratory consultant had been reasonable, as was the advice to urgently redirect to cardiology and immediately commence A on a diuretic.
“On the matter of the timing of A’s cardiology review,
we found that this was unreasonable in light of them having significant indicators of heart failure, known to date back.”
The SPSO ordered NHS Fife to apologise to C for the delays in assessing and treating A’s condition.
Commenting on the ruling, NHS Fife Director of nursing, Janette Keenan, said: “We strive to provide all patients with the highest standard of care. We accept, however, that there were aspects of the care we provided in this instance that fell short of those high standards.
“We have implemented the Ombudsman’s recommendations in full and have formally apologised to the family involved.”