Inadequate information for man discharged from hospital with ongoing symptoms

Deputy Health and Disability Commissioner Kevin Allan today released a report finding a district health board (DHB) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in the care of a man with ongoing testicular swelling and pain.

The man was admitted to hospital with a four-day history of swelling in his left testis, pain in his lower abdomen and groin, nausea, and fever. He was diagnosed with inflammation of the epididymis (part of the testis) and provided with intravenous antibiotics and strong painkillers.

Over the following four days, the man’s condition appeared to improve, and he was discharged from hospital with oral antibiotics. His documented discharge plan was for him to return home, complete his 10-day course of antibiotics, and continue taking strong painkillers.

His discharge summary advised him to "seek medical attention" if he experienced "worsening pain, fevers, red/hot/swollen scrotum". The man recalled that he was advised to return to hospital if he deteriorated or remained in pain.

The man re-presented to hospital 10 days later, as his left testis was still painful and swollen. An ultrasound revealed that no blood flow could be seen within the testis. The man was transferred to another hospital for surgery. During the surgery, it was discovered that part of the left testis was necrotic (dead), and the testis was removed.

Deputy Commissioner Kevin Allan accepted that there was evidence that the man was verbally advised to return to hospital in a week’s time if he had not improved, but considered that the man was not provided with sufficient information about follow-up at the time of discharge.

Given his ongoing symptoms and his risk factors, including not having a GP, Mr Allan considered that the lack of information resulted in a delay in the man re-presenting to hospital and receiving timely care. He also criticised the DHB’s documentation of the man’s care.

"This case highlights the importance of hospital staff providing sufficient information to patients when they are discharged with ongoing symptoms," said Mr Allan.

"I find that [the DHB] failed to ensure that it provided [the man] with the information that a reasonable consumer in his circumstances would expect to receive."

Mr Allan recommended that the DHB use this case as an anonymised case study to provide staff training on discharge information; develop staff guidelines on written discharge advice and definitive follow-up plans; and provide a written apology to the man.

The full report for case 18HDC01344 is available on the HDC website.