Decision Report 201801122

Summary

Mr C complained about the treatment he received from an emergency nurse practitioner (ENP) when he attended Stobhill Hospital. Mr C had injured his hand a number of weeks previously and other health professionals had said he had suffered some soft tissue damage. Mr C told the ENP that he thought he had perhaps broken a bone in his hand. He said that they did not listen to him and as a result arranged for him to have a standard x-ray which was not appropriate for identifying a fracture in the specific bone he thought was broken (the hamate bone - located on the outside of the wrist).

We took independent advice from an ENP. We found that hamate fractures are rare and difficult to diagnose. There was some disagreement between the ENP and Mr C about what was actually discussed during the assessment. There were aspects of the ENP's record-keeping which were not to an appropriate standard in that they lacked detail about the exact physical examination which had taken place. However, they had taken a reasonable history from Mr C and we felt that, due to the low suspicion of a bone fracture, it was appropriate to direct Mr C to his GP should the problem persist. Emergency departments would not have access to the specialist x-ray which would have identified a hamate fracture and this would come under the remit of specialist hand or orthopaedic surgeons (surgeons who specialise in the musculoskeletal system). We did not uphold the complaint.