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Assessment of baby in Emergency Department

Health and Disability Commissioner Anthony Hill today released a report finding Waikato DHB and a doctor who worked there in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures relating to a baby’s ED presentations.

A woman took her six-month-old son to the Emergency Department (ED) at the local hospital as the baby had flu-like symptoms. She took him a further three times over the next six days as the baby had an ongoing fever and was developing new symptoms. At the fourth visit, the baby’s condition was discussed with specialist paediatric services at a main centre hospital and he was transferred to its care. He remained in hospital for another month.

Mr Hill said repeated presentations of a baby to ED were a ‘red flag’.

He was critical that at one presentation ED staff failed to take a full set of observations and at two of the presentations repeat observations were not taken prior to discharge.

"In my view, incomplete and single sets of observations can be misleading, whereas repeat observations may demonstrate a trend towards clinical improvement or deterioration," Mr Hill said.

"The responsibility for ensuring that accurate and timely observations are taken rests with both the medical and the nursing staff in the Emergency Department. This represents a pattern of poor practice in respect of an essential aspect of care."

Mr Hill criticised the DHB for failing to ensure that its staff were using its paediatric assessment chart for ED attendees appropriately. He was also critical that there was no referral to a specialist paediatric service earlier, noting that the DHB had no policy requiring consultation with specialist paediatric services when a baby re-presents.

The Commissioner found the doctor who reviewed the baby on the third presentation in breach of the Code for his clinical decision not to refer the baby to a specialist paediatrics service.

Mr Hill recommended that the doctor and the DHB apologise to the baby’s parents, and, should the doctor return to practice, that the Medical Council of New Zealand undertake a review of his competence. Mr Hill also recommended that the DHB undertake an audit to ascertain compliance with the use of its assessment chart for ED paediatric attendees, and provide training on consultation with specialist paediatric services and on the frequency of observations required for paediatric patients.

The report for case 16HDC01594 is on the HDC website.

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