North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742consider these concerns represent a failure to deliver an appropriate standard of care. Therewas a delay to definitive care of her congestive heart failure, but I don‘t consider this to be ofgreat significance, nor to represent a concerning standard of care. The delays relate to theissues already raised about patients being admitted to North Shore Hospital, and will bediscussed further in this advice.In summary, it is my opinion that [Mrs B] was assessed and managed to an appropriatestandard, while in the ECC.Comments about [Mrs E’s] care in ECCAlthough not specifically asked to comment on [Mrs E‘s] care, it is relevant to my brief.[Mrs E] raised concerns about care in both the ECC and in the ward. Her concerns areinformed by her knowledge of the system and are in the context of concerns about otheraspects of care from previous encounters with the system.In relation to the ECC she was concerned about cleanliness, difficulty getting care whenneeded and delays to treatment.Although [Mrs E] had prompt initial nursing care (including the insertion of an intravenouscannula and the performance of initial investigations) it is clear that definitive care for hercondition was delayed. She, like the other patients subject to this investigation, 99 was a directreferral to the General Medical team. She waited in a busy, overcrowded ECC for assessmentby the team. After that she was given specific treatment for her condition (antibiotics, fluidsand prednisone) and then a bed was allowed to be ordered.Although the process for acute General Medical admissions was followed (Pathway Two,above) [Mrs E] was made to suffer care in an overcrowded ECC (and therefore less nursingattention than she might have expected) and delays awaiting management by the GeneralMedical team.I appreciate her distress, waiting with an acute exacerbation of shortness of breath, feeling asif she was abandoned or ignored at times, and knowing she needed treatment of a certain type,but having to wait before it was delivered.Comments about care of the patients in wards 10 and 11I have not been asked to comment on the care in the medical wards, although I note similarissues to those raised in relation to the care in ECC. I have seen the complaints and thestatements from staff, and I participated in interviews of some key staff members. I noteconcerns from staff about high acuity over winter, vacancies, staff sickness and a need to relyon junior and bureau staff. [Mrs B][Mrs B‘s] family record concerns about delays to response to calls for assistance, failure toappreciate deterioration and poor communication. I have read the patient records and all ofthe statements. Commenting on the specific medical and nursing care is outside my brief, butI am of the opinion that timeliness of interactions, and quality of communication may havebeen compromised by workload. [Mrs C][Mrs C] was treated on the ward for congestive heart failure. She deteriorated and died,unexpectedly, after a change to her pain killer medication. The family have raised concerns99 In fact, Mr D self-referred to ECC, unlike the other four patients who were referred by their doctor.April 2009 121