KEY POINTS:
One man died and two others suffered unduly after receiving insufficient treatment due to short staffing at three New Zealand hospitals, the Health and Disability Commissioner has found.
Commissioner Ron Paterson released reports today, which criticised the way the three hospitals handled the cases.
A 25-year-old man died from a rare back condition in April 2007 less than 12 hours after he sought treatment at Christchurch Hospital's emergency department.
The hospital had given him pain medication then discharged him three hours later.
His condition deteriorated overnight and he died at home.
The commission's emergency medical advisor Dr Garry Clearwater said the man had an epidural abscess, which presented in an atypical manner.
"He was managed by a relatively inexperienced junior doctor in a chaotic busy department.
"In a setting of reasonable workload and on-site active supervision, I expect that the atypical features of [his] case would have been more readily detected."
Mr Paterson said there was a number of gaps in the patient's care.
"This case highlights the threat that overcrowding poses to patient safety."
The shortcomings of the Canterbury District Health Board were not confined to it and over-crowding in emergency departments was a national and international problem, he said.
"It will take a concerted national effort to tackle these problems.
"Even in a well resourced emergency department patients with rare infectious disorders may not have their condition detected, but it may be some comfort to families to know that every reasonable precaution was taken."
The DHB had made changes such as increasing staff numbers and providing staff with education for assessing back pain after an independent review in July 2007.
Mr Paterson recommended the DHB apologise to the man's family and review its emergency department further.
In a second case a man was sent home from Wanganui Hospital in September 2007 with an undiagnosed broken back.
He had fallen five metres onto his back while snow boarding.
The first doctor he saw ordered chest and spinal x-rays.
However, there was a very high demand for emergency department and radiology services that night and a second doctor issued instructions about mobilising and discharging him.
He went home, without formally being discharged and experienced pain and numbness overnight.
He went to another hospital the next day where he was diagnosed with a spinal fracture.
He had orthopedic surgery, was admitted to the spinal unit for rehabilitation and was discharged in mid December that year.
Wanganui DHB said since the incident it had increased staff in its emergency department and changed its layout and processes reducing x-ray waiting times.
Mr Paterson said the hospital staff had not sufficiently communicated with the patient to track his condition or given him any discharge advice about managing his symptoms .
He accepted the DHB had been short staffed.
"That, however, does not excuse the district health board from its duty to provide an emergency department with sufficient staff and robust systems to withstand fluctuating demands and ensure that good communication occurs between staff and patients."
He recommended the second doctor responsible for the patient apologise to him and undertake additional training in spinal injuries.
The DHB should run an educational update with staff for spinal injuries and review its discharge processes, he said.
Another man complained to the commissioner after the Hutt Hospital took two months to discover he had a subdural haematoma.
The 67-year-old man had been assaulted while walking his dog on December 13, 2006.
He was examined at the Hutt Hospital emergency department and discharged, but his condition deteriorated over the following weeks.
He twice returned to the emergency department and his general practitioner referred him to the hospital for outpatient assessment.
On February 11 a CT scan found the haematoma.
He was immediately transferred to another public hospital for a burr hole evacuation of the clot and made a good recovery.
After the incident the Hutt Valley DHB made a number of changes including altering its emergency department guidelines for assessing headaches, ensuring new doctors are educated about head injury guidelines and recruiting extra junior doctors to cover late shifts.
The commissioner said he was critical of some aspects of care, but because staffing was inadequate most of his criticism was directed at the emergency department processes.
The Hutt Valley DHB did not have adequate systems in place or adequate staffing, he said.
It was likely poor communication between departments in the hospital contributed to the delay of finding the haematoma, Mr Patterson said.
Requiring staff to work back to back shifts, as the doctor who first saw the man did, was "damaging to staff health and morale, and may place patients at unacceptable risk", he said.
However, he praised the DHB for the improvements it had made and for apologising to the patient.
- NZPA
