"Negative Orthopaedic Clinic and Telehealth Experiences"

About: Royal Perth Hospital / Outpatients Surgical Clinic Telehealth Service - WACHS Pilbara

(as the patient),

There are several issues I would like to feedback relating to my experience with the patient care I received at the Royal Perth Hospital Orthopaedic Clinic and Telehealth follow-up consult.

1. Orthopaedic Clinic - I felt they were inconsiderate and insensitive

Earlier this year I attended the Orthopaedic Clinic as a follow-up to remove 26 staples and review my emergency knee operation which was carried out a month prior. I arrived in a wheelchair with my brother and approached the reception counter where 3 staff members sat. Two of them were engaged in a private conversation and other staff member in the middle where we stood was working on her computer. We stood there and not one staff member acknowledged our presence. After a while the one who was working on their computer looked up and we advised we were here for my appointment. I was told to wait until I was called. I felt their behaviour was discourteous and disrespectful.

Acknowledging the room was crowded with patients, I was required to have the specialist complete a PATS (Patient Assisted Travel Scheme) form, and asked the staff member who spoke to us if they could provide us with the forms. The staff member looked confused and said they did not know what PATS was. They then turned to the other two staff members who stopped their conversation, one pointed to the TV  saying, the forms are under the TV over there. There was no offer of assistance. I rolled my wheelchair over to the where the forms were only to find the last copy of page 1 of the 4 pages required. I felt annoyed and chose not to engage with them, but rang PATS in my home town, who forwarded the required documentation to the clinic.

My appointment was booked for 9am, when I was called into see my specialist, I was requested to go down to get x-rays required for the review and was sent down to RPH x-ray and return with them before 12.00pm as my doctor's clinic finishes at 12pm.

I returned with my x-rays and my brother and I were called into a cubicle to remove my staples while my doctor reviewed my staples. I was met by a nurse, who set me up on the bed. I sat there nervously as the nurse removed the dressing and revealed the staples. I took pics of the injury as it was the first time I saw the wound since the injury. My expectation was that some form of topical anaesthetic would be applied prior to the removal of the staples. I made light conversation with the nurse as they unpacked the dressing tray, but was most surprised when they merely swabbed the wound and began removing the first of the 26 staples.

I can say nothing more than that the pain was excruciating, yet even though I was clearly distressed, the nurse continued with the task and when I asked if they could put a cream or some sort of local anaesthetic, they explained without apology - I can't give you anything as it would take time to take effect and we don't have the time as we have to get patients through as the clinic is full.

I was shocked by the nurse's response, and the fact that she would tell this to a patient, but overwhelmingly so by her lack of compassion. While I tried my best to endure the pain I requested the nurse stop and sobbed at my brother to find the panadol in my bag and requested some water, so I could take the tablets. The nurse gave me some water and continued to remove the rest of the staples.

I was pained, horrified and angered at the treatment I received. In my opinion it was unacceptable and inexcusable. I felt somewhat helpless as I knew the staples had to be removed, but the lack of care I felt was astounding. Had I been a more aggressive person I have no doubt the procedure would have stopped and immense confrontation would have resulted.

I wonder if staff in those high stressed service areas could not be given periodic refresher courses in patient care and experience or rotated to lessen the constant pressure they may feel.

 

2. Second Operation follow-up and Telehealth Consult

Following on from the above specialist review I was told the 1st operation was not a success and a second operation was required, and was immediately booked in for admission the next day. Needless to say I was adamant that the specialist use sutures and not staples. As a note of interest  my doctor seemed surprised that staples were used in the first operation and indicated that he always used sutures.

I was discharged a number of days later and returned to my home town with instructions to attend via Telehealth within 2 weeks to review the operation and remove the sutures. 

At the beginning of the suggested 2 week time-frame,  I had not been contacted to confirm my telehealth appointment, which according to my discharge advice was due the next day. I rang to confirm this and was told there was no booking for telehealth as yet and telehealth officers would not be available. I advised that I had sutures that needed removal, as it had been nearly 20 days and they advised me to attend at 9.00am to outpatients to remove my sutures and see the physio. 

I was also advised to contact Perth. The Telehealth Centre advised that I did not have an appointment and the next available appointment wasn't for another couple of weeks. Not being available on that date, the appointment was made for another week on - 6 weeks after the operation.

There was no post-operative contact with me up until the telehealth appointment, even though I had had several sessions with the Physio. I was concerned there was no set rehabilitation program or instructions relating to my medications. If x-rays were required for the Telehealth consult and was told no i did not.

When I presented for the consult, the surgeon requested I go and get x-rays. It seemed like there was a lack of effective communication and follow-up between the surgeon's clinic, Telehealth Perth and the Regional Telehealth.

Responses

Response from Penny Curtis, Clinical Risk Manager, Patient Safety Team, WA Country Health Service (WACHS) Pilbara

Thank you Glome42, for providing feedback to WA Country Health Service in the Pilbara on your experience of the delayed Telehealth appointment on site at Hedland Health Campus after your 2nd operation at Royal Perth Hospital. That is frustrating and concerning to hear that you had to follow up about your own Telehealth appointment 2 weeks after the operation and that you weren’t seen via a Telehealth appointment until 6 weeks after the operation. Your care was poorly coordinated after you were discharged and I apologise to you.

Your feedback has been read by the WACHS Pilbara Regional Director Margi Faulkner, the Operations Manager at Hedland Health Campus Brian Wilson, as well as the WACHS Telehealth Manager and Coordinator at Royal Perth and our local Pilbara Telehealth Coordinator. The poor coordination of your care between the Metro Hospital and Regional Telehealth has been discussed at a joint meeting between RPH and WACHS to ensure an accurate understanding of where issues arose and the improvements that can be made. As a result of your feedback there are new changes that are being made to processes for Telehealth appointments.

We are already working on improvements to the technical systems that support telehealth appointment bookings so that this process is more integrated across the health sites involved. We have identified new communication strategies that will be implemented between RPH Outpatients and Regional Telehealth so that urgent appointments are scheduled more effectively and to ensure that other requirements for the appointment (such as x-rays and other investigations) are completed when needed. A key part of this is to make sure that patients are kept informed during the process if there are issues with scheduling appointments.

Our Regional Director is passionate about country consumers receiving seamless follow up care in the region, especially after care provided in the city. It is clear your experience was not good and I’m sorry that this occurred. With the recent growth of Telehealth providing follow up consults for country residents it is really important that country residents are seen via VC technology where they live based on what the discharge summary recommends is medically necessary. Thank you again for providing this feedback, and allowing us the opportunity to improve our services for future patients.

I appreciate your story has been posted anonymously. If you would like further feedback from WA Country Health Pilbara you are welcome to speak with the Regional Director Margi Faulkner on (08) 9174 1600 or contact WACHS-Pilbara Complaints And Compliments WACHSPB_Complaints@health.wa.gov.au to go through our complaints process for more specific feedback on your individual situation.

Kind regards,

Penny Curtis

Regional Clinical Risk Management Coordinator

Patient Safety and Quality Team - Pilbara

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Response from Aresh Anwar, Executive Director, Royal Perth Bentley Group

picture of Aresh Anwar

Dear Glome42,

Thank you for taking time to share your recent experience at RPH. I would like to begin by offering my unreserved apology for what has obviously been a very traumatic experience for you.

Our staff at RPH are expected to always provide a high level of service to patients as they attend clinics and I am sorry that we failed to provide this service to you on your arrival. This is not acceptable and it is something that I have already raised with our senior leadership team to address.

It saddened me to read about your experience relating to the removal of your staples. While we normally do not provide any anaesthetic for the removal of your staples and patients may experience some slight discomfort, it should never be painful. The attending nurse should have escalated this to medical staff as there must have been an underlying cause for the pain. I cannot apologise enough for this and I have asked our Director of Nursing to investigate this further.

With regard to your follow-up Telehealth appointment, once again I am embarrassed to read how we have failed you. All patients should be kept informed and you have identified a communication breakdown between the RPH Telehealth service and the regional Telehealth service which we are now addressing with the relevant areas.

I can see this has been traumatic for you, but in the interest of preventing this from happening again, I would like to ask if you could assist us by contacting my office directly on 9224 2219 so that I can get some more information from you to investigate this matter further and prevent it from occurring again in the future.

Following the investigation, I will be writing to provide you with more detailed outlines of the final actions taken.

Thank you again for sharing your experience, as it is through such feedback that we can improve our service in the future.

Sincerely

Dr Aresh Anwar

Executive Director

Royal Perth Bentley Group

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