20. Before we decide if we should conduct a detailed investigation of 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 have not seen any indications that something has gone wrong.
21. Mrs A believes the Trust discharged her too soon after her surgery on 5 April. She says she was originally told she would be kept in for seven to ten days but was discharged after three days. Mrs A says if the Trust kept her in for longer, it would have identified the issue earlier and prevented it, or treated it sooner, and this series of events and scarring would not have occurred.
22. The Trust says Mrs A likely had an infected seroma after surgery in April. This is where fluid collects under the skin after surgery and becomes infected with bacteria.
23. There is no medical standard or guideline on when a patient should be discharged from hospital following hemicolectomy surgery. Our adviser explains the length of a patients stay in hospital after this operation typically ranges from three to seven days. Although some services send patients home after one or two days if they are well enough to do so.
24. The GMC’s Good Medical Practice says doctors must provide a good standard of care. If doctors treat patients, they must adequately assess the patient’s condition. Our adviser explains it is important that the patient is considered safe to be discharged.
25. Our adviser explained it is general practice to monitor a number of signs to tell if a patient is safe to be discharged. These signs include normal observations of heart rate, blood pressure, respiratory rate, and temperature, and whether they are tolerating oral liquids and some soft diet. It also includes pain after surgery; it is usually adequate if oral painkillers are enough to control the patient’s pain. It is not absolutely necessary to wait until a patient is opening their bowel.
26. A Trust will also consider a patient’s social circumstances, such as whether they live alone and are able to look after themselves.
27. From Mrs A’s procedure until the date of her discharge, all her observations were within normal ranges. She was tolerating oral liquids, and she was eating and drinking well. Her pain was well controlled, with her not using her PCA and declining most medications. Her bowels were also opening, and she was independently mobile. All of these signs showed Mrs A was medically fit for discharge.
28. Moreover, when the Trust removed the drains from Mrs A’s wound, the wound was healthy and there were no signs of infection. Mrs A also reported to feel well, she had no concerns about her discharge and was able to look after herself independently at home.
29. The Trust therefore adequately assessed Mrs A in line with the GMC’s Good Medical Practice after her surgery. From the outcome of these assessments, there was no reason for Mrs A to stay in hospital any longer.
30. Cancer Research website explains that infection of the wound is a known risk of surgery for colon cancer, and that this may require another operation. Clinical studies, such as studies 1 and 2 noted above, also shows that wound infection is a known common complication, and in study 2, 49% of those who developed a wound infection, did so after they were discharged from hospital.
31. Our adviser explained that staying in hospital therefore would not have prevented Mrs A’s wound infection as it is common for these to present after discharge from hospital. There is also a risk of getting an infection the longer a patient stays in hospital.
32. We appreciate this was painful for Mrs A and took a long time to heal. We hope it brings her some reassurance that it is unlikely this could have been avoided if she stayed in hospital longer. Wound infection is a recognised complication risk of bowel surgery. We have seen no indications anything went wrong in the Trust’s actions. For this reason, we will take no further action on this.