When an overloaded ED gets it wrong, who should be accountable?
A recent case involving a patient harmed in an overcrowded ED highlights the need for a fresh look at how NZ investigates clinical errors.
In New Zealand, crowded emergency departments are a common sight at this time of year, reflecting the strain on the health system. For patients, long waiting times to see a doctor are a reality. However, for clinicians dealing with workforce shortages and rising demand, it can mean making tough decisions in challenging circumstances.
This pressure has led the New Zealand Nurses Organisation to advocate for enforceable safe staffing levels. A recent report from the Health and Disability Commission (HDC) highlights an unfortunate example of these pressures. A 55-year-old man, who went to the ED with severe chest pain, was misclassified and had to wait four and a half hours for a heart attack diagnosis, which ultimately resulted in his treatment.
The HDC's adverse event review concluded that Health NZ had breached the Code of Health and Disability Services Consumers’ Rights. While recognizing the system's pressures and recommending improvements, the HDC's findings emphasized the failure to correctly assess the patient's symptoms and ensure timely evaluation. The case illustrates the difficulty in separating individual clinical judgment from system pressures.
In emergency departments, nurses must make rapid decisions about which patients require urgent care, a task made more challenging in overcrowded settings. Overcrowding can lead to defensive triage, where nurses assign more urgent categories to reduce the risk of misclassifying patients. However, these approaches do not address the root problem of insufficient staff and resources.
Clinicians involved in adverse events can also experience significant personal impacts, a phenomenon known as the "second victim" effect. While accountability for patient harm is crucial, the investigation process for such complaints may need to evolve. Health NZ's adverse event review, while focusing on system improvements, was conducted differently than the HDC process.
The HDC's investigation, based on clinical records and written accounts, took three years to conclude. With the Health Quality & Safety Commission's focus on understanding why adverse events occur and using them to improve the system, a more restorative approach to complaints could better serve patients and clinicians. This approach would shift the emphasis towards understanding what happened, the harm caused, and what is needed to prevent it from happening again, while still maintaining accountability.
Written by urgent.news from The Conversation AU's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
