Mr H's story

Mr H, who was 67 years old, developed necrotising fasciitis while recovering from a hernia operation. Hospital staff failed to recognise the seriousness of his condition at an early stage, and he waited more than 16 hours for the emergency surgery he needed.

banner-image3
’The consultant must be involved if critical care is needed but cannot be arranged.‘Royal College of Surgeons

What happened

On 2 March Mr H had surgery for a large inguinal hernia descending into the scrotum. A drain was left in the wound to allow any fluid to pass out. This continued to discharge, delaying his return home. Mr H’s family remarked on a foul smell from the wound, but this was not mentioned in his health records.

Mr H was finally discharged on 16 March, but the next day the GP was called because he was generally unwell. Mr H’s son recalled that ‘everywhere he sat in the house, he left a damp patch and foul smell’. The GP sent Mr H to the emergency department, arriving late in the evening. The paramedic recorded low blood pressure. However, the nursing triage assessment was not recorded, and there was no indication that any account was taken of Mr H’s low blood pressure and the urgency of the GP’s concerns.

Critically ill patients have priority over elective patients – including delaying routine surgery if necessary (Royal College of Surgeons)

Around three hours later Mr H saw a doctor, who noted a large area of dead tissue over his lower abdomen. The doctor realised that Mr H was seriously ill – he had necrotising fasciitis. Mr H was given intravenous fluids and antibiotics, and was referred for emergency surgery to remove the dead tissue. However, surgery was delayed until more than 16 hours after Mr H’s arrival.

Mr H had extensive surgery to remove the dead tissue, and his postoperative care was complicated and slow. In all, he was in hospital for 15 months and suffered numerous illnesses. One leg was also amputated. Mr H’s son said that his father: 'had gone from being a relatively healthy man with a hernia to being unable to move far from his chair. He should have been playing with his grandchildren and enjoying his retirement now, but he can’t.’ He said that ‘no amount of money can ever repay my father for his lack of dignity, mobility and pride’. Mr H never fully recovered and died a year later.

What we found

We found failings in the poor assessment of Mr H when he was readmitted to hospital, the delay in treating sepsis, and the delay in carrying out the emergency surgery. We also criticised the way the Trust dealt with the family’s complaint about Mr H’s care and treatment.

What happened next

In line with our recommendations, the Trust apologised to Mr H’s family and paid compensation to his wife. The Trust also drew up plans to address their failings. Their action plan included implementing the Manchester triage system in the emergency department, and introducing the ‘patient at risk’ and pain-scoring systems to improve patient assessment on arrival. They also planned to revise their guidelines for managing sepsis.

Summary of failings against standards

Clinical care

 

Timely history and examination on  admission or referral.

  Regular physiological monitoring using track and trigger systems.
 

Basic resuscitation with:

 
  • Large volume fluid therapy
 
  • Intravenous broad-spectrum antibiotics after taking cultures
 
  • Vasopressor therapy if required to maintain adequate haemodynamics and tissue perfusion.
  Source control to be performed as soon as possible after initial resuscitation.

Organisation of care

 

Appropriate and timely referral for source control.