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AUGUST, 2015

Emergency department mixups
Treatment delays
Avoidable readmissions

The patient was on time but her medical treatments were delayed.

Jennifer was a fifty year old woman, who experienced a sudden onset of visual disturbances and confusion.

She had seen the ads on television, saying ‘if you feel you are having a stroke, go straight to the emergency department’.

Jennifer felt sure this was happening she was having a stroke.

So she rang a taxi, and made her way to an emergency department within in half an hour. She told the triage nurse at the front desk all about her symptoms.

The nurse checked her vital signs then told her to sit and wait…

…emergency was very busy. Nurses and doctors were rushing past. Everyone seemed to be doing something important.

Finally Jennifer was taken inside the Emergency department.

But instead of being quickly assessed, she was moved by attendants from one cubical to another.

It seemed more like a game of ‘musical beds’ than medical care.

At one stage a nurse appeared, asked a few questions, got Jennifer to change into a gown then rushed off.

Another nurse appeared, did a blood pressure, wrote down the results and also rushed off.

At one stage a junior doctor came in, examined Jennifer and ordered an ECG.

After waiting on a trolly in Emergency for six hours Jennifer had undergone three sets of observations, one set of bloods and a cardiac test. Her initial symptoms had still not resolved. A senior doctor ordered a CT scan of her brain.

This scan showed that she experienced an ischaemic stroke, caused by a clot in one of her brain blood vessels. It had blocked off part of the brain’s blood supply.

 

By now it was too late for Jennifer to be given the appropriate treatment, an intravenous dose of ‘clot busting’ drugs.

The emergency doctor explained that the clot busting drugs can only be given within three hours of a stroke occurring.

“But I’ve been waiting here for over six hours” cried Jennifer.

“I told the nurse at reception that I was having a stroke. I’ve seen the symptoms on the TV. Why didn’t anyone see me sooner?”

The doctor apologised.

Jennifer was admitted to a stroke ward. Where she waited…

The next day a neurologist came to review her.

He advised Jennifer that she had missed out on very important treatment. The neurologist expressed his frustration about the mixup up in the Emergency Department.

The only treatment Jennifer was now able to receive, was a simple blood thinning tablet.

After several days she was then discharged home.

iv drip

The same afternoon, Jennifer experienced another episode of visual disturbances. She quickly called an Ambulance. Who drove her back to the same Emergency Department that had left her waiting without life saving treatment, several days earlier.

Jennifer was very distressed and angry.

“Nobody cares about me” she cried.

© Wikihospitals 2014

Timely treatment after stroke is crucial, UCLA researchers report – UCLA June 2013
Heart attack treatment depends on where you are – The Age August 2013