"Undiagnosed broken foot following xray"

Dear pilingsqx53,

Thank you for taking the time to explain your journey- and how disapointing to have your fracture missed- and the trips back and forth to get the moon boot. I am so sorry because this delay in getting the fracture recognised is certainly NOT connected care, best experience that we strive to provide.

There are a couple of things about your story

-we are looking into missed or delayed fracture diagnosis that happen in ED- so thank you for contributing your story and letting us explore how we can do this better. So, we are hoping to make a change- but I can't be sure how we will do this better, so please expect that I will come back to you on this platform when we have a better process so that fractures like yours don't get missed.

-I sense that you think the Doctor should have known how to apply the moonboot, however different products have different instructions, and most of these resources are online these days. We do encourage staff to check if they are not quite sure on how to do something.

-I am really appreciative of your acknowledgment of the nurse who was pointing out the misdiagnosis to the Doctor. We do work very closely with all different professionals in a multidisciplinary way, and rely on this team work- in most of our areas, and in particular ED.

-I note that what you could see wasn't visable to the Doctor on the X Ray, and we are very mindful of our clinical staff, and indeed all staff who get fatigued, and miss things that would otherwise have seemed obvious. Managing fatigue is a really important part of how we try to work, and trying to minimise staff working longer hours than rostered, or missing meal breaks. Sometimes I don't think we get this quite right. Sometimes the staff aren't tired but they have a lot of things happening at once, so concentration and attention to detail is critical too. Again, I am sure you are aware of this- but it is something that we are always looking at and trying to address, or support better ways of working that help the patients get the care that they need.

Again, thank you for your story, it has prompted us to review this and why fractures get missed and why this is occurring, and I will be back in touch hopefully within the next month with what we are planning to do to improve fracture diagnosis in our ED.

Kind Regards

Chloe