Impossible to meet standards every time, says emergency doctor

1.00pm

Despite improvements to Wellington Hospital's emergency department since the death of Nileema Sharan, there would always be days when Australasian standards were not met, the hospital's senior emergency department consultant Dr Marjory Vanderpyl says.

Miss Sharan, 25, died of meningococcal septicaemia on June 26 last year -- the day after travelling by ambulance to Wellington Hospital's emergency department, after apparently hurting her neck at work.

She waited almost three hours to be seen but eventually gave up and saw a doctor at an urgent medical centre.

Wellington Coroner Garry Evans found Ms Sharan might have lived had hospital and emergency staff recognised the seriousness of her illness.

He criticised the emergency department delays and prioritisation process, the lack of communication between the emergency department and the medical centre general practitioner, and the GP's failure to take a complete history.

Dr Vanderpyl told National Radio today that standards could not always be met simply because of the unpredictable nature of emergency medicine, including being unable to predict the number of people needing treatment at any time.

"We have the standards as a goal and we expect to achieve, for instance with triage category three (patients with undefined serious problems), we aim to try to get 60 per cent of those people seen within -- preferably much earlier -- than 30 minutes," she said.

The department had been "pretty full" at the time Ms Sharan had been there, with patients waiting to be seen and be admitted to the hospital.

Significant improvements had been made to the emergency department since Ms Sharan's death.

The number of nursing staff at the department had been increased by five last year, and had remained at that level, Dr Vanderpyl said.

An independent review of nursing numbers had found present staffing levels to be appropriate, although there were about three vacancies.

"We are also getting an increased number of senior medical officers -- of consultants -- who will be able to increase the amount of cover that we, as consultants, will cover the department.

"They have significant process changes throughout the department and looking at how we see the patients acutely, and also in terms of the hospital as a whole because everything impinges on each other," she said.

"There's been an improvement in the process of discharging patients from hospital, in having beds available in the hospital so patients can leave the department and don't spend too long waiting for an admitted bed."

Emergency services clinical director Dr Robyn Toomath said there was definitely a chance the outcome in Ms Sharan's case would have been different had she visited the hospital now.

"We would always hope that there would be a chance of picking up these cases, even if they were missed before, and certainly... a lot of the processes have changed," she told National Radio.

"We undertook an extensive review prior to the coroner's report coming out, and in essence we agree with his recommendations about the staffing levels and the process changes.

"We've been very keen to implement these as soon as we possibly could and this is what we've gone ahead and done, so I hope things would be different," Dr Toomath said.

Gridlocking of emergency departments was a problem throughout the world and Wellington had been doing extensive reviews to see if people could be moved out of hospital so beds could be made available within the hospital.

Dr Toomath said she had been upset to hear that Ms Sharan's mother, Radhika Mani, did not feel she had received an official apology.

"I've been in this position a short time. I know that all of the staff involved in the hospital from (Capital and Coast District Health Board chief executive) Margot Mains downwards have felt deeply regretful about Nileema's death and would have extended their greatest sympathy to the family.

"We would be very happy to meet with them. I know Margot Mains has extended this offer recently and in the past and we would be very, very keen to do so again to express our deep regret."

- NZPA