The Princess Alexandra Hospital NHS Trust

4. Mrs V complains about the care and treatment provided by the Trust on 9 October 2023, when she attended the Emergency Department (ED). She says the Trust failed to diagnose her abscess and failed to provide treatment to prevent her abscess from worsening.

5. On 16 October, Mrs V became unwell whilst she was on holiday abroad. She attended hospital and was diagnosed with a prepatellar abscess and inflammation of the bursa sac in front of her kneecap. This affected her holiday, delayed her return home and caused her considerable inconvenience reclaiming expenses through her insurance. She also says it has taken her a while to regain the full use of her leg.

6. To resolve her complaint, Mrs V seeks an acknowledgement of failings, an apology for the impact and service improvements. She would also like a financial payment.

7. On 4 October 2023, Mrs V felt pain in her right knee whilst gardening. She visited her GP who suspected cellulitis, a skin infection, and was prescribed a course of antibiotics.

8. On 9 October, Mrs V retuned to see her GP after her symptoms did not improve. Her GP suspected septic arthritis, a joint infection usually caused by a bacterial infection. He referred Mrs V to the ED for an X-ray.

9. Mrs V attended the ED and was examined by an ED doctor. The doctor noted a red and inflamed rash over Mrs V’s right knee below her kneecap. The doctor recommended an X-ray and a routine blood test.

10. The X-ray results were normal. Mrs V’s blood results showed a slightly elevated C-reactive protein (CRP), indicating inflammation in her body.

11. Mrs V was provided with a treatment plan and discharged with safety netting advice (information on what to do if symptoms change or worsen).

12. On 13 October, Mrs V went on holiday and during the holiday she felt unwell.

13. On 16 October, Mrs V attended hospital with swelling and inflammation just below her right knee and she was admitted. She was diagnosed with a prepatellar abscess and inflammation of the bursa sac in front of her kneecap and prescribed antibiotics. An abscess is a collection of pus that forms within body tissue, in this case between the skin and kneecap. Bursa are fluid-filled sacs underneath the skin that cushion the joints of the knee.

14. The hospital took imaging tests of Mrs V’s knee and found a mass. On 18 October, a biopsy was taken of the mass to gather samples for further testing.

15. On 23 October, Mrs V was informed that she was fit to fly home and she returned to the UK.

16. Remaining unhappy with the responses to her complaint, Mrs V asked us to consider her complaint.

20. Mrs V complains the Trust failed to diagnose her abscess and failed to provide treatment to prevent her abscess from worsening.

21. Mrs V attended the ED after a referral from her GP for suspected septic arthritis (infection of a joint) in her right knee. She had been taking antibiotics for several days for cellulitis.

22. When the ED doctor examined Mrs V, there was a red and inflamed rash over Mrs V’s right knee below her kneecap. BMJ guidance says septic arthritis presents with a hot, swollen, acutely painful joint with restriction of movement. In the ED, Mrs V was able to weight bear and bend her knee to 70 to 80 degrees, and she had no difficulty walking.

23. The ED doctor recommended an X-ray of Mrs V’s right knee and a routine blood test. The results of the X-ray were normal, and the ED doctor noted there was no evidence of the following symptoms:

• swelling over the knee joint • bony tenderness • ulcers • bleeding outside of blood vessels • numbness over the limb • loss of sensation • motor loss • increased pressure restricting blood flow.

24. Mrs V’s blood test results showed a normal white blood cell count and a slightly elevated CRP. Our adviser says Mrs V was already on antibiotics for inflammation around the knee that may have led to the rise in her CRP.

25. Mrs V says she had an on and off fever. At the time she was examined in the ED, Mrs V’s temperature was 37.1°C. This is generally considered within the normal range for adults and did not indicate a fever.

26. Mrs V was prescribed antibiotics and discharged with advice on what to do if she experienced any pain, loss of sensory or motor function, if her rash spread or there was no improvement after taking the antibiotics.

27. Our adviser confirms that Mrs V had an appropriate assessment in the ED. She was examined by an ED doctor and had an X-ray and blood tests to investigate if she had septic arthritis. The results did not indicate that Mrs V had septic arthritis at that time. Mrs V was appropriately discharged in accordance with RCEM guidance which says discharge advice should include ‘safety netting’. Mrs V was given advice of what to look out for and was provided with antibiotic treatment.

Conclusion

28. We recognise Mrs V has strong views about what happened, and she believes there were failings in her care and treatment. We hope Mrs V is reassured that we have carefully reviewed the clinical records, with assistance from a suitably qualified and experienced clinical adviser.

29. Mrs V’s GP referred her for suspected septic arthritis, and as we have explained, the ED doctor acted appropriately in examining Mrs V, and did not find any indications of this condition.

30. Mrs V complains to us that the Trust failed to diagnose her abscess. Our adviser says there was no clinical indication Mrs V had an abscess when she attended the ED. Our adviser has explained it is likely Mrs V’s cellulitis did not respond to the antibiotics, and in time, this infection developed into the abscess that was later diagnosed.

31. We do not see any indication of failings on the part of the Trust and for this reason, we have decided not to investigate further. We recognise this may be a disappointing outcome for Mrs V and we hope she can appreciate the reasons for our decision.

1. We have carefully considered Mrs V’s complaint about the Trust. We were very sorry to hear of her concerns.

2. We have decided not to uphold Mrs V’s complaint as we have not seen any indication of failings in the care and treatment provided by the Trust.

3. We recognise the significant emotional distress Mrs V has experienced, and hope this statement provides her with assurance and fully explains our decision.