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Emergency Department Care Results In Delayed Diagnosis Of Stroke

Health and Disability Commissioner Anthony Hill today released a report finding a district health board (DHB) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for the suboptimal care of a woman in a public hospital’s emergency department (ED).

The woman in her thirties went to the ED three times over the course of 10 days with symptoms of dizziness, nausea and vomiting, and falling to the left when trying to walk. Clinical staff failed to assess or examine the woman appropriately on her visit to ED, and on returning to ED the woman experienced significant delays of up to five and half hours waiting to be seen by doctors. On her third visit to ED the woman was incorrectly given a low triage priority and again experienced delays in being seen by doctors, which resulted in a delayed diagnosis of stroke.

Mr Hill was very critical of the long wait times the woman experienced in ED. While Mr Hill acknowledged the constraints on the ED at the time of the events, he noted: "[A] busy environment under pressure does not remove the obligation to provide appropriate services, and does not remove provider accountability for ensuring the appropriate steps are taken."

Mr Hill also commented on the value of having a support person present, especially where the patient is vulnerable or may require help in navigating the information provided.

Anthony Hill recommended that the DHB review the waiting times for ED; use the report as a case study for further training in ED; develop guidelines for acute onset vertigo; and provide education for staff on the appropriate triage category for a suspected stroke. Mr Hill also recommended that the DHB apologise to the woman.

The full report for case 18HDC01465 is available on the HDC website.

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