Summary
Mr C complained about the care his father (Mr A) received at the Royal Alexandra Hospital's A&E department after attending there with a severe headache. Specifically, Mr C complained that Mr A was not reviewed by a doctor for several hours and there was a delay in taking a CT scan of his head (computerised tomography scan: a specialised x-ray). Mr A had a subarachnoid haemorrhage (SAH: a bleed on the brain). He was transferred to a hospital with specialised services where he suffered a seizure and died.
The board said that Mr A was seen by a doctor within ten minutes of arriving at A&E and that an immediate CT scan had not been performed as Mr A's neurological examination was normal. However, he was admitted to a medical ward with the intention of carrying out a CT scan. The board considered whether there were any lessons to be learned. Consequently, the department have lowered the threshold for when a CT scan should be arranged if a SAH is suspected when neurological examination is normal.
We took independent advice from two of our medical advisers and found that Mr A was assessed promptly by an emergency doctor who had suspected a SAH. However, we were critical that the board would normally only arrange a scan if there was a neurological decline. We considered a scan should have been arranged as soon as the doctor suspected a SAH in line with national guidance. In any case, when Mr A's condition declined in A&E, a CT scan was not arranged until a further decline happened several hours later on the ward.
We were also critical that there was no record to show that the doctor had discussed the merits of arranging a CT scan with the on-call consultant. This was not in line with the General Medical Council's good practice guidance on record-keeping.
Recommendations
We recommended that the board: apologise to the family for failing to arrange a timeous CT scan in line with national guidance; review their local protocol on the management of headaches to ensure it is in accordance with national guidance; and draw to the attention of the emergency doctor the importance of recording discussions about the management of patients in line with good practice.
Related reading
View Decision Report 201403602 as a PDF (13.41 KB) Updated: March 13, 2018