North Shore Hospital report - New Zealand Doctor

Health and Disability Commissionerplanning and documentation for Ms A. Neither Mrs B nor Mrs E receivedsufficient monitoring and documentation of care. Both women were experiencingbreathlessness, yet Mrs E‘s respiratory rate was not recorded and tracked andthere is no indication that the effectiveness of the therapy for Mrs B‘s respiratorydistress was monitored.ECC nursing staff also paid insufficient attention to Mrs B‘s positioning as shebecame increasingly breathless. There is conflicting information about thismatter. The notes record that she was ―elevated‖ by the nurses prior to medicalreview. About an hour later when her son returned he found his mother on apillow, but still lying too flat given her breathlessness. It appears that Mrs B waseither not positioned well enough to begin with, or she subsequently slipped ormoved and the nurses were too busy to notice and reposition her. This was poorcare.Mrs E also reported waiting up to 30 minutes for her call-bell to be answered.ECC was particularly busy the day that Mrs E was admitted, with 206presentations in 24 hours. The nurses were responsible for 12 to 20 patients insome zones. Clearly they had to prioritise tasks. However, I do not accept that theDHB had taken adequate steps to plan and provide for days like this, which wereto be expected over the winter period. Although there was only one nursingvacancy in ECC at this time, not enough attention had been paid to ensuring thatthere were sufficient staff to cope with actual demand.SummaryMs A, Mrs B and Mrs E did not receive services of an appropriate standard, orconsistent with their needs, at North Shore Hospital ECC. All three patientsexperienced care that was, at times, poorly co-ordinated, delayed and focused on thetask rather than the patient. I accept the advice of my expert emergency medicinespecialist, Dr Ardagh, that these deficiencies in care were largely the result ofinefficient processes for medical admissions, and the workload of ECC staff.Waitemata DHB was aware that North Shore Hospital ECC was suffering fromovercrowding, bed-block, inefficient systems and staffing issues. Despite theseconcerns being consistently raised by staff, the DHB failed to take sufficient action toplan and provide adequate resources and systems for patient care. There were seriousomissions, in light of the evidence that overcrowding in emergency departments isdirectly related to poorer patient outcomes. 86 In relation to the services provided to MsA, Mrs B and Mrs E in North Shore Hospital ECC, Waitemata DHB breached Rights4(1) and 4(3) of the Code. In Mrs B‘s case, the DHB breached Right 4(5) by poor coordinationof her care.There were not simply failings in care. All these patients were, by virtue of the longdelays they experienced in an overcrowded emergency department, treated without86 Studies from Australia and the United States report an approximately 30% increase in overallmortality if patients are admitted through overcrowded emergency departments to overcrowdedhospitals: Institute of Medicine, Committee on the Future of Emergency Care in the United StatesHealth System, Hospital-based Emergency Care: At the Breaking Point (Washington DC, NationalAcademy Press, 2006).64April 2009