Diagnosis and treatment 17. Mr W has concerns the Trust misdiagnosed Mrs W and did not appropriately treat her for food poisoning. He says the Trust incorrectly focused on a diagnosis of diverticulitis and this did not align with the diagnosis given by the GP and ambulance service.
18. The Trust says the working diagnosis was gastroenteritis and diverticulitis, which was reasonable based on her clinical presentation.
19. On 13 November, Mrs W presented at the Trust with a four-day history of diarrhoea and vomiting. On examination she had pain on her abdomen. The Trust’s initial working diagnosis was gastroenteritis. Later that day, the Trust made a diagnosis of gastroenteritis during the ward round.
20. The gastroenteritis CKS advises clinicians to suspect a diagnosis of gastroenteritis if a person presents with sudden onset diarrhoea, vomiting, fever, or abdominal pain. Mrs W was presenting with three of these symptoms, supporting that a diagnosis of gastroenteritis was in line with guidance on admission.
21. On 14 November, a doctor examined Mrs W again. It was noted she had tenderness in her lower side. Due to her previous history of diverticular disease, the doctor queried whether some of her pain could be attributed to diverticulitis.
22. The gastroenteritis CKS prompts clinicians to also consider a range of other conditions that may present similarly to gastroenteritis as a differential diagnosis. This incudes diverticulitis. The guidance advises to consider this if a patient has a history of diverticular disease, as Mrs W did.
23. The Trust did not make a definite diagnosis of diverticulitis, but queried if it could be contributing to the pain. It decided to prescribe treatment just in case, alongside the treatment for gastroenteritis. The Trust started Mrs W on metronidazole, an antibiotic, as a precaution.
24. From a diagnostic point of view, the diagnosis of gastroenteritis with a query around diverticular disease was in line with the above guidance.
25. The gastroenteritis BNF explains gastroenteritis is ‘self limiting’, meaning it usually resolves by itself without the need for treatment. It sets out antibiotic therapy is not usually indicated.
26. For diverticulitis, antibiotics are not recommended straight away but should be considered if systems persist. Metronidazole is listed as an appropriate antibiotic if necessary, so this prescription was In line with the BNF guidance based on the working diagnosis.
27. The majority of patients that present with diarrhoea and vomiting generally have gastroenteritis, which is usually self-limiting. It is treated with fluids, avoiding antibiotics, as set out in the guidance. This reflects the treatment Mrs W received and was in line with the guidance.
28. We recognise Mr W had serious concerns around Mrs W’s diagnosis and subsequent treatment and hope this can provide him with some reassurance the Trust acted in line with guidance.
Test reporting 29. Mr W has specific concerns that there were errors with the Trust’s reporting system, which caused a delay in recognising Mrs W had campylobacter. He feels there was an opportunity to have known Mrs W had campylobacter sooner, and she could have been treated, preventing her deterioration and death.
30. The Trust has acknowledged there was a delay in its reporting on Mrs W’s stool sample. It says this was because the result failed to queue on the system.
31. The gastroenteritis CKS says if a patient presents with gastroenteritis, to arrange for a stool culture sample, based on clinical judgement. The Trust sent a sample in line with this guidance on 13 November. The sample confirmed Mrs W had campylobacter.
32. The records support there was a delay around the reporting of this result. The sample was not reported until 6 December. There is no specific national guidance around reporting times, but information from the Trust suggests the standard reporting time is a few days. There appears to have been an issue with the Trust’s system as it says there was a glitch with the report getting onto the system.
33. Based on this, as the sample was taken on 13th November, it is reasonable to expect this should have been available three days later by 16th November. This means the first stool sample should have been available whilst Mrs W would still have been alive, and it would have been known she had campylobacter. The Trust did not report on this in line with its own timeframes. We think this is a failing.
34. Our adviser has carefully considered the impact of this delay, specifically if Mrs W could have been treated sooner, or the outcome avoided. We acknowledge Mrs W should have been diagnosed with campylobacter whilst she was still alive and are mindful Mr W has very serious concerns about this. We will explain our findings in full below.
35. The BMJ best practice guidance for campylobacter infection explains it is usually self-limiting, resolving itself without treatment. It usually presents as diarrhoea and abdominal pain and vomiting is a less frequent symptom, suggesting this is not a typical presentation.
36. Once campylobacter is identified, the BMJ guidance recommends treatment by fluids, which Mrs W was appropriately receiving. It says antibiotics are not generally indicated, unless a patient has symptoms for over a week, bacteraemia (bugs in the blood) or blood in diarrhoea.
37. Mrs W’s observations confirm she did not have bacteraemia, or blood in her stool. Based on her clinical presentation and in line with the BMJ guidance, antibiotics would not have been considered until 17 November, which is the day she sadly died. Mrs W had a cardiac arrest on the morning of 17 November, and giving an antibiotic on that date would not have prevented this.
38. From this, we can be reassured even if the diagnosis of campylobacter had been known in a timely manner, the treatment would not have changed. Mrs W was receiving the full and recommended treatments as is set out in national guidance.
39. This is not to detract from the failings we have identified, and that the results should have been available. We do recognise the distress Mr W has since faced, having the worry that there was a direct link in the test reporting to Mrs W’s death, and it could have been avoided. We do not underestimate how difficult it must have been to have to navigate these worries.
40. Whilst we recognise there were mistakes in the reporting, we hope it can offer Mr W some comfort that the very sad outcome could not have been avoided.
41. We have considered the steps the Trust has taken to recognise the distress caused by the reporting delay, leading to Mr W worrying about if the outcome could have been different.
42. The Trust has acknowledged there was a delay in the reporting due to the result failing to queue on the system. Whilst it has acknowledged this happened, it has not apologised for this or recognised the worry this mistake caused.
43. We are pleased to see the Trust has acknowledged there is some learning to be taken from the case generally. This is not specific to the failing we have identified.
44. Our complaints standards say organisations should give meaningful and severe apologies and explanations that openly reflect the impact on the people concerned. They also say they should take action to make sure any learning is identified and used to improve services.
45. We are yet to see action has been taken to sufficiently remedy the impact we identified. We therefore recommend the Trust take further action to put this right.