Two complaints over the past year, at São Francisco Xavier Hospital. Conclusions of the inquiry were revealed.
O Hospital Saint Francis Xavier left forgotten vaginal pads after giving birth in two women, which led the regulator to warn of the need to guarantee users’ right to receive more correct care.
The first complaint to the Health Regulatory Authority (ERS) was made on February 24, 2025 and the second on May 12 of the same year, complaints that led to the opening of a inquiry, whose conclusions were known today.
In one case, the forgotten compress was detected by the user herself six days after being discharged from hospital, while in the second it was 26 days since the birth, said the ERS in the deliberation released today.
“It is true that the verification of two identical situations, in such a short space of time (two months), highlights a significant weakness in care protocols then implemented at the Western Lisbon Local Health Unit (ULSLO), compromising the effective safeguarding of the quality and safety of the health care provided”, concluded the ERS.
In its response to the regulator regarding these cases, the hospital reported having implemented corrective measures to avoid similar situations, through the preparation of “measures to prevent and control the retention of clinical materials in the birth canal”, aimed at the medical and nursing teams that are part of the obstetric and gynecological emergency service and the delivery unit.
Despite this, the ERS issued an instruction to ULSLO to ensure that “the legitimate rights and interests of users are respected, in particular the right to the most appropriate and technically correct care, following good quality and health safety practices”.
Furthermore, the hospital must ensure that all instruments and/or compresses used during any intervention are properly counted e registered in the users’ records and correctly removed prior to their discharge, he said.
The ERS also issued an instruction to the Santa Maria Local Health Unit, following the case of a user who was admitted to the emergency room on April 3, 2024 with suspected stroke and who only had her first medical observation around seven hours after the screening.
According to the regulatory body, the user was screened at 14:21 with a yellow bracelet (urgent) and only “for 21:33 had the first medical observation”, at which time Via Verde AVC was activated, when the stipulated care time for urgent situations is 60 minutes.
“It should be noted that the user was not monitored by any professional, nor was she subject to rescreening, which was otherwise mandatory after the target time for clinical observation (60 minutes) had been exceeded”, highlighted the ERS.
ULS Santa Maria said that, on the day in question, there was a “high number of patients” – 384 – who resorted to the emergency service, which meant that the observation time was not as expected, and ensured that the “observation timing” [da utente] did not change the approach taken”.
Following this case, ERS issued an instruction to ULS Santa Maria to also ensure that, among other measures, “there are the legitimate rights and interests of users are respectedthat is, the right to adequate and technically correct care, which must be provided humanely and with respect for the user”.
