4. Mr O complains information about his heart rhythm was not shared with him in a correct and timely manner following his surgery at The Dudley Group NHS Foundation Trust (the Trust) on 4 November 2019.
5. Mr O says because of not being told about issues with his heart, he has lost trust in the clinicians.
6. Mr O wants the Trust to apologise and provide an explanation as to what went wrong.
7. On 26 October 2019, Mr O attended the emergency department (ED) with a severe diabetic infection in his right foot. On 4 November 2019, Mr O attended hospital to have an amputation of several toes on his right foot. Mr O has no cardiac clinical history and is diagnosed with type 2 diabetes.
8. While in surgery, the anaesthetist noted an inverted T-wave on Mr O’s echocardiogram (ECG) readings and requested a blood test and a 12-lead ECG. This is a heart test that is recorded using twelve leads attached to the body. The Trust anaesthetist notes the reason for this is that they did not have a comparable previous ECG to review.
9. The day after his surgery, Mr O recalls a nurse explaining to him something was wrong with his heart during surgery. A doctor then explained to Mr O that his heart rhythm had changed in surgery but that this was normal.
13. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and, we have not found any indications that something has gone wrong.
Background on the echocardiogram (ECG)
14. We included a background on the ECG to help explain the reasons why Mr O was given one. We did not investigate this part of Mr O’s care but, to help him to understand the way he was communicated with, we wanted to explain the reasons he had an ECG. This is because he told us he had concerns about it not being fully explained to him. We were sorry to hear of Mr O’s experience and appreciate it must have been concerning for him to feel information was being kept from him.
15. Mr O complains on 5 November 2019, the day after his surgery, clinicians failed to inform him of the abnormality with his rhythm strip. He said he was concerned the Trust was dishonest in not thoroughly explaining the abnormality with his heart. He says he has now become paranoid he may have an underlying problem with his heart.
16. NICE guidance says an ECG is not required for minor surgery, in the absence of any major underlying health conditions. Our adviser explained as Mr O was admitted with a diabetic foot infection, the surgery to treat this was classed as minor, and so an ECG prior to his admission was not recommended.
17. The research paper we used (Annals of Noninvasive Electrocardiology) explains inverted T-waves (an abnormal result) on an ECG, without any other abnormalities, does not mean there is a problem with the heart. Sometimes it can be a small abnormality which needs to be looked at. The research paper says it is good practice to request a follow up ECG to rule out possible heart disease.
18. Once Mr O was in surgery on 4 November 2019, we saw from his records that his rhythm strip chart showed he had an inverted T-wave on part of that strip. This did not suggest heart disease or a problem with his heart. It was simply an abnormal result which best practice says should be followed up.
19. Our adviser explained theatre ECG machines are not as accurate as a 12-lead ECG. Therefore, a follow-up 12-lead ECG is usually requested if abnormal results are found in theatre. In Mr O’s case, the anaesthetist at the Trust requested a 12-lead ECG and blood test after noting the inverted t-wave during the procedure. The anaesthetist noted there was no previous ECG to compare the results with. As stated above, this was not a requirement prior to surgery given the type of surgery Mr O had.
20. We saw from Mr O’s records the 12-Lead ECG undertaken on 4 November 2019. It showed normal results. We also reviewed Mr O’s hospital discharge summary and saw no evidence of any concerns regarding Mr O’s heart, or requirement for follow up action once he left hospital.
21. If there were concerns about Mr O’s heart, we would have expected to have seen this in his medical records. From the information we looked at, we saw no problem with Mr O’s heart, which is the reason it was not written in the medical records. We hope this will provide Mr O with the reassurance he is seeking regarding the need for the 12-Lead ECG post procedure.
Communication
22. GMC’s Good Medical Practice (Paragraph 31) says doctors must listen to patients, take account of their views, and respond honestly to their questions. GMC’s ethical guidance on decision making and consent (Paragraph 22) says it wouldn’t be reasonable for doctors to share every possible risk of harm, potential complication, or side effect. Instead, doctors should tailor the discussion to each individual patient, guided by what matters to them, and share information in a way they can understand.
23. Our adviser explained there was no injury or disease to Mr O’s heart and the clinicians looked after him very well. They explained the small problem with the ECG was quickly recognised and investigated, and the 12-lead ECG showed no abnormality.
24. Mr O complains on 5 November 2019, the day after his surgery, clinicians failed to inform him of the abnormality with his rhythm strip straight after his procedure. Mr O says a nurse asked him whether he was feeling well after his surgery and he responded asking them why they asked. Mr O said the nurse informed him there was a concern about his heart while he was in surgery, and he recalled them looking concerned.
25. Mr O says he was reviewed by a doctor who explained his heart rate had increased in surgery, like that of ‘running from walking’. Mr O says the lack of communication caused him to become paranoid about his heart and has eroded his trust in clinicians.
26. On 22 December 2020, the Trust provided Mr O with a final response letter to his complaint, following a local resolution meeting. The doctor (Dr 1) involved in providing the response was a consultant vascular surgeon and governance lead.
27. Mr O said in the meeting that he asked a doctor whether there were any concerns relating to his heart and he was reassured there was no cause for concern. Dr 1 went on to explain the doctor’s response in this case would have been standard practice following a normal ECG, as medical staff try to keep discussions with their patients relevant, to avoid causing unnecessary distress or anxiety.
28. We reviewed Mr O’s operation record from 4 November 2019, which detailed the amputation on his right foot. The doctor noted Mr O’s T-wave was inverted during the procedure and that he would need a 12-lead ECG and a blood test.
29. We reviewed Mr O’s medical records for 5 November 2019 and saw no entry showing a discussion had taken place with Mr O about his rhythm strip results. We saw an entry that day by a physician associate (a healthcare professional supervised by a doctor) who noted Mr O as being settled and not experiencing right foot pain following his surgery.
30. Based on the evidence, if the Trust thought Mr O had a heart problem, this would have prompted further investigation specifically related to his heart. Had this happened, we would have expected it to have been communicated to him and be included in his medical records.
31. In this case, we saw no evidence there was a problem with Mr O’s heart function and do not consider clinicians discussing this with him was necessary. We think this is supported by the fact Mr O had a 12-lead ECG after surgery, which is considered more accurate and detailed than a theatre ECG, and the results were normal.
32. We found there was nothing to investigate following Mr O’s normal 12-Lead ECG and therefore no reason to discuss anything further with him. We consider the brief discussions the doctor and nurse had with Mr O post-procedure about his abnormal heart rhythm was enough. We are satisfied the Trust followed GMC and NICE guidance, and as such, do not consider the lack of communication with Mr O an indication of a failing.
1. We have carefully considered Mr O’s complaint about The Dudley Group NHS Foundation Trust (the Trust). We have seen no indication that anything went wrong.
2. We think the Trust did not need to discuss Mr O’s rhythm strip with him because we did not see there was a problem with his heart. We did, however, find that after his surgery a nurse and a doctor briefly told Mr O about his abnormal heart rhythm during surgery. From our review, we do not think there was a requirement for the Trust to go further than this.
3. We were sorry to hear how Mr O has lost trust in the NHS because of what happened to him.