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Woman dead after 12 hours in Wellington ED

#1 User is offline   BLURB 

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Posted 18 May 2015 - 05:41 PM

Woman dead after 12 hours in Wellington ED
Last updated 17:10, May 18 2015

A Wellington woman who died in an emergency department 12 hours after being admitted with chest pain was let down by the district health board, the Health and Disability Commissioner has found.

In a decision released on Monday, commissioner Anthony Hill found Capital & Coast District Health Board's treatment of the 51-year-old woman suffered from "unacceptable delays", with staff admitting that, on the busy shift, they were unable to properly monitor her.

CCDHB too has admitted there were some "systems failures".

The woman's care suffered because the emergency department was stretched by influx of patients, which "led to congestion and overcrowding in ED", the decision reveals. At the time, in mid-2012, emergency department patients deemed to need a medical assessment within 30 minutes were waiting, on average, for more than an hour and half.

"In my view, the care provided ... fell well short of accepted standards," Hill said.

"Several of the individuals who provided care to Mrs A hold a degree of responsibility for the shortcomings in Mrs A's care. However, overall, I consider that the shortcomings in the care provided to Mrs A occurred in the context of deficiencies in the systems operating at CCDHB."

The woman was first admitted to the emergency department at 3.31pm, with shortness of breath. From the beginning, she was incorrectly classified as needing to be seen by a doctor within 30 minutes, rather than within 10 minutes, Hill said.

Even then, the woman was not seen until more than an hour after being admitted.

As her condition deteriorated over the following 12 hours, staff failed to adequately monitor or treat her condition. She complained of chest pains, which were deemed a likely chest infection by staff, despite her history of heart problems.

There were no records of her being seen by a senior doctor and it's unclear whether any doctor saw her blood test results, which should have triggered an immediate response, Hill said.

At 3.20am the next morning, more than 12 hours after she arrived, her heart failed and, half an hour later, she was declared dead.

Capital & Coast chief medical officer Geoff Robinson said in a statement that the DHB accepted all of the commissioner's finding and had apologised to the woman's family.

"We deeply regret that in this instance our systems did not support staff to provide timely care."

He said the DHB's performance in the emergency department had vastly improved since the woman's death, with changes including better senior doctor supervision and cover, telephone follow-up on lab results, and better orientation of junior doctors.

As a result, the number of emergency department patients transferred or discharged within six hours – a national target against which all DHBs are measured – had risen from 76 per cent in 2012 to 96 per cent last month.

- Stuff

#2 User is offline   unit1of2 

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Posted 18 May 2015 - 09:55 PM

OK this is very sad!! Whilst the hospital states they have learnt and made changes to improve everything.... What a crock... sorry. I personally have one of those letters whereby they say 'they are making improvements blah blah blah'...... What a load of crock!!

Nothing changes. Unless they sack people or strike them off for being 'slack' and causing harm or death due to 'slackness'... nothing changes!

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