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Discharge from ED without adequate information (12HDC01019)

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(12HDC01019, 12 June 2014)

Ambulance service ~ Public hospital ~ Emergency department ~ Senior medical officer ~ Emergency medicine specialist ~ Bicycle accident ~ Cervical spine ~ Spinal cord injury ~ X-ray ~ Transient quadriplegia ~ Discharge ~ Right 4(1)

A man was riding a bicycle when he collided with a stationary vehicle. Upon impact his helmet shattered into a number of pieces and he fell to the ground. The man was unable to move his limbs immediately following the accident. This condition is known as transient quadriplegia.

About 15 minutes later an ambulance crew arrived at the scene. By the time the ambulance crew arrived, the man could again move his limbs. There is no record in the ambulance crew's notes of the man's inability to move his limbs immediately following the accident. The ambulance crew immobilised the man and took him to the public hospital's Emergency Department.

The triage nurse in the Emergency Department noted that the man denied pins and needles in his limbs, but had felt he could not move his limbs after the accident. Following triage, he was seen by a senior house officer. The senior house officer recorded the man's current symptoms in the clinical notes, but he did not record the man's earlier transient quadriplegia. The senior house officer requested X-rays of the man's cervical spine, thoracic spine and shoulder. The X-rays were reviewed by the senior house officer and a senior medical officer. Both doctors noted that the cervical spine X-rays were incomplete. However, after examination they determined that the man had no clinical signs of a cervical spinal cord injury. The man was discharged with prescriptions for pain medication and told to come back if the pain worsened or did not improve. Following discharge, the man experienced a number of adverse effects from the accident. During the course of subsequent treatment, medical investigation revealed that the man had suffered a spinal cord injury from the accident.

As the senior doctor with overall responsibility for the man's care and management, the senior medical officer made a decision to discharge the man without sufficient information about his condition, including his history of transient quadriplegia, and without adequate views of his cervical spine X-ray. Furthermore, she did not provide the man with head injury advice on discharge. Accordingly, the senior medical officer failed to provide services to the man with reasonable care and skill and breached Right 4(1).

Adverse comment was made about the senior house officer's failure to take an adequate history from the man. The documentation the senior house officer completed on the senior medical officer's behalf did not include all relevant information, as it should have. In addition, adverse comment was made about the ambulance crew's failure to record the man's transient quadriplegia.

It was held that the district health board did not breach the Code. 

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