Mrs X’s discharge on 5 March 2024
15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the Trust has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
16. Mrs X experienced multiple complex long term health conditions, notably ischaemic heart disease (a condition where reduced blood flow and oxygen supply to the heart muscle causes damage) and heart failure, chronic lung and kidney disease and rheumatoid arthritis. She was anaemic and investigation was planned for this when her acute health concerns allowed. Further treatment for ischaemic heart disease could be considered when anaemia had been investigated. Our physician adviser said that unfortunately these significant health conditions meant that Mrs X was at risk of an acute worsening of her health at any time, whether she was in hospital or at home.
17. Our physician adviser also noted that in addition to the health conditions, Mrs X was also living with frailty (mildly to moderately frail by Rockwood frailty scale criteria rockwood-frailty-scale_.pdf) which would further impact her ability to withstand and recover from acute worsening of her health.
18. Mrs X had frequent hospital admissions in the months before her death relating to the chronic conditions but also additional acute health issues. With regard to this admission, Mrs X was an inpatient between 30 January and 5 March 2024, (aside from a brief discharge 26 February 2024 following which she was readmitted). The medical records indicate that during these two admissions Mrs X was treated for heart failure and pneumonia (chest infection), and the symptoms of chest pain, breathlessness, headache and dizziness were further explored. Extensive investigations were performed, including comprehensive body imaging (a CTPA which images the chest including blood vessels, a CT abdomen scan, a CT head scan, a MR brain scan), ECGs and blood tests.
19. Mrs X received specialist assessments during these admissions that included advice from the cardiology, rheumatology and microbiology teams, with outpatient follow up planned with cardiology and rheumatology. Our physician adviser confirmed that the medical input that Mrs X received appears to be both thorough and appropriate.
20. Regarding Mrs X’s discharge, our physician adviser said Mrs X was assessed by the medical team on the day of discharge at 09.43am and considered appropriate for discharge home as planned. The NEWS score was zero (indicative of a low chance of acute illness). The NEWS is based on a simple aggregate scoring system in which a score is allocated to physiological measurements including respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness and temperature.
21. Furthermore, “Annex D” of the Hospital discharge and community support guidance (Hospital discharge and community support guidance - GOV.UK) includes a list of criteria indicating whether a person continues to require acute hospital care, and review and challenge questions for the clinical team to consider. Our physician adviser said from these indicators Mrs X did not require ongoing acute care and could be considered medically optimised for discharge.
22. We note other key factors for discharge planning had taken place. Mrs X’s care needs had been considered and discussed with her. Discharge planning had involved the multidisciplinary team and during admission she had been regularly assessed by the therapy teams. A discharge checklist was completed on the day of discharge.
23. The available information indicates that Mrs X was appropriately discharged on 5 March 2024. Mrs X sadly died on the day of discharge from hospital but there is no indications from the medical records that this was predictable or anticipated, nor that there were any omissions in her discharge planning.
24. In summary, we have carefully considered Mr X’s complaint. There are no indications of failings relating to the discharge of his wife. Therefore, we do not consider we need to take any further action regarding his complaint. We recognise the importance of this matter to Mr X and we hope we have clearly explained the reasons for our decision.