Patient unreasonably discharged twice in one day after day–case surgery

Summary 654 |

Mr C had day surgery at Surgicentre, a private company that provided services to the NHS. He was unreasonably discharged twice and both times he had to be re–admitted.


What happened

Mr C was admitted for surgery as a day case to the Surgicentre, which at the time was run by Clinicenta Limited. Staff discharged him after the procedure, but when he arrived home, he noticed that he was still bleeding heavily from the operation wound. He had to return to the Surgicentre, where staff took action to stop the bleeding. Later, he was discharged again when his blood pressure was low, but on the way out of the building, he collapsed. He had to be admitted overnight to hospital.

What we found

We partly upheld this case. Although the bleed was an unfortunate complication of this procedure, both discharges were unreasonable. On the first occasion, nursing staff did not check the dressing before telling Mr C he could leave. The second time, Mr C's blood pressure was low and he should have been kept in for further observations before being discharged. The surgeon had not kept adequate records, but this did not appear to contribute to Mr C's distress.

Putting it right

Clinicenta no longer provides NHS services, so we made no recommendations to improve its service. We did, however, ask it to pay Mr C £500 to recognise the avoidable distress that he had experienced. Clinicenta agreed to do so.

The surgeon agreed to consider and reflect on our findings regarding his record keeping.

Health or Parliamentary
Health
Organisations we investigated

Carillion PLC Health Services (Clinicenta Ltd)

Location

Hertfordshire

Complainants' concerns ?

Came to an unsound decision

Result

Not applicable