North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742a suitable placement for their father, and met with the manager of a private hospital.They were advised that a bed was available.Mr D was discharged to the private hospital at 2pm on 18 October, but returned toNorth Shore Hospital ECC at 11pm that evening because the family were concernedabout his increasing shortness of breath.Mr D‘s deteriorationThe ECC registrar examined Mr D on his return to North Shore Hospital, and foundthat his heart condition was very serious and potentially fatal. Mr D‘s family wereadvised of his condition. They agreed to a trial of chemical cardioversion, 45 but statedthat if their father had a cardiac arrest he was not to be resuscitated. A chest X-ray inECC showed that Mr D had a pneumothorax, but the medical staff decided not treatthis condition because he had poor quality of life, was not able to sit up, and insertinga chest drain would be traumatic. Mr D was given morphine to keep him comfortable,and he died at 3.30am on 19 October 2007.Mrs E (17 to 19 October 2007)BackgroundMrs E (79 years) suffers from asthma. After caring for her husband during hisrecovery from bowel cancer surgery and radiotherapy, Mrs E became generallyunwell, with fever, coughing and difficulty swallowing and breathing. After a bout ofvomiting and diarrhoea, she was referred to North Shore Hospital by her medicalpractitioner for assessment and treatment of possible pneumonia.North Shore Hospital ECCThe North Shore Hospital records show that Mrs E was admitted to ECC at 2.53pm 46on 17 October 2007 and triaged in the Acute Zone. Mrs E was assessed by aregistered nurse who found that she was breathing rapidly and experiencing somedifficulty taking a breath. Mrs E was pale and her skin was cool and clammy, but hervital signs of temperature, pulse and blood pressure were not concerning. The nurseperformed an electrocardiograph (ECG), introduced an intravenous cannula, tookblood for laboratory analysis, and designated Mrs E as triage category 3 (ie, to be seenwithin 30 minutes).The North Shore Hospital computerised patient tracking system (PiMS) records thatMrs E was assessed by the medical team house officer at 4.30pm, although Mrs Erecalls it was 6.30pm.The medical team house officer decided that she was suffering from an exacerbationof chronic obstructive pulmonary disease (COPD) and asthma with probable rightlower lobe pneumonia. Mrs E also had diarrhoea and was vomiting. His treatmentplan was to admit her to a medical ward, and start her on courses of prednisone and45 A method of restoring the normal rhythm of the heart of patients with increased heart rate due toarrhythmia, using medications. Controlled direct-current shock or medication is used.46 Mrs E believes that this is incorrect, as she left her GP‘s rooms at 1.46pm. However, the St JohnAmbulance records indicate that Mrs E was uplifted from the GP‘s rooms at 2.30pm and arrived atNorth Shore Hospital at 2.50pm.April 2009 27