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"Appendicitis and long wait time"

About: Joondalup Health Campus / Emergency Department

(as the patient),

I presented to an Urgent Care centre with acute abdominal pain that had manifested on the evening a couple days ago. Following excellent timely assessment by the staff there, they transferred me to Joondalup Health Campus ED, via ambulance, with the diagnosis of appendicitis.

I was given Penthrox (green whistle) for the ambulance ride as my pain score was 10 out of 10 which helped immensely. I had the shakes from the pain and positive for rovsing. On route to ED the Paramedic explained to me the meaning of ramping and in my case that might occur.

I arrived at JHC ED just before midday, ambulance entrance, and waited for approximately 15 minutes (which I feel is appropriate) before being reviewed by a nurse, who as I understand it decided that I did not need the green whistle, I did not need to stay on the ambulance trolley, I did not have appendicitis, and could go and wait in the waiting room along with everybody else. I repeated that I was transferred with appenditicis to which I believe the nurse said I look too well for that, it's more than likely gastro.

The nurse walked me into the waiting room, asked me to pee in a cup (would be tested straight away) and take my turn, I recall advising me along the way that there was a 4 1/2 hour wait! I went to the bathroom and peed in the cup, vomited and nearly fainted as well. I returned to the triage nursing window and said what had just happened, repeating that I had presented with appendicitis and was advised to take a seat in the green chairs and a nurse would come and see me. I was given ondansetron and told to sit in a pink chair as more comfortable and told to put my feet up on a chair. My spouse was advised that they could not stay with me as ED waiting area was full.

During my time in ED waiting room, I went to the nurses triage window twice and repeated the reason for my presentation, and that my pain was escalating, nausea getting worse and shaking. The waiting room nurses reviewed me and gave me oxycodone twice for the pain. At the time of my last dose of oxycodone, I was informed by the nurse that a doctor might come and review me in ED waiting area, take some bloods from me and start a drip, but no one appeared.

My spouse when they returned after midday with my phone, I believe was told they were not allowed in as the premier had changed the rules to no visitors, we later found out this was not true. So I was alone in the waiting room with no advocate. I was finally taken through to ED about 5 hours 20 minutes after my admission to JHC ED.

Whilst I appreciate how busy ED can be, and was on this particular day, my main complaint is that I believe I was misdiagnosed right from the beginning when I presented in the ambulance, by the nurse who saw me on the ambulance trolley. It seemed to me they overruled the admitting doctors diagnosis from Urgent Care, and I feel this led to me remaining in ED waiting area for so many hours.

During the hours I waited in ED, I believe other people with less life-threatening presentations were seen before me, so therefore the triage system was clearly not working, in my opinion. The reason I know this as there is no privacy in the waiting room so you can hear everyone's presentations.

On my admission paperwork to JHC ED, I recall it clearly states abdominal pain and nothing else. As I understand it, my urine sample was still in my file waiting to be tested when I was seen by the ED Doctor 5 and 1/2 hrs later, so I believe had not been tested at all. I believe the ED doctor was shocked I had waited so long to be seen, with what they diagnosed straight away, just by feeling my abdomen, as appendicitis.

On CT scan at later that night, I was formally diagnosed with appendicitis, localised perforation, early abscess and free fluid in abdomen. I was then reviewed by surgical team and scheduled for emergency surgery that night. I was on IV Tazocin for 48hrs, due the extent of the infection caused by my perforated appendix.

During my admission in A1, I was provided with exceptional care, by all members of the muitidiciplinary team who I dealt with, in particular nurse Erica and Nurse Shinae. As a result of sharing my experience with you, I feel some changes to the triage system may need to occur so that in future no one else has to experience what I experienced in your ED. Thank you for taking time to read this feedback.

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Response from Paul Taylor-Byrne, Deputy Director of Clinical Services - Acute Care, Ramsay - Joondalup Health Campus 4 months ago
Paul Taylor-Byrne
Deputy Director of Clinical Services - Acute Care,
Ramsay - Joondalup Health Campus
Submitted on 18/01/2022 at 5:24 PM
Published on Care Opinion at 5:25 PM

picture of Paul Taylor-Byrne

Dear sculptorrw84,

Thank you for providing your feedback on Care Opinion and giving us the opportunity to read and reflect on your experience in our hospital. As a hospital dedicated to providing a high standard of emergency care, we are sorry to read of the concerns you have raised regarding your care whilst attending the Joondalup Health Campus (JHC) Emergency Department (ED) and are happy to read of your positive experience on Ward A1.

When arriving to JHC ED all patients are assessed by experienced senior Emergency nurses using the Australasian Triage Scale (ATS) which is an assessment of clinical acuity. The ATS aims to ensure that patients are treated in order of their clinical urgency which refers to the need for time-critical intervention. Patients are seen according to the clinical severity of their presentation and therefore some patients will be seen sooner after their arrival than others due to their presenting condition.

Once triaged, patients then wait for an available location within the ED that best suits their clinical needs. The length of time a patient may wait does vary depending on clinical acuity, the area within the ED the patient is allocated to and the current demands on that area. The wait time for non-life-threatening situations will vary depending on the acuity and volume of patients in the department.

The JHC ED strive to meet the WA Emergency Access Target which requires that 90% of all patients presenting to a public hospital emergency department will be seen and admitted, transferred or discharged within 4 hours. Depending on the number of presentations to ED on a given day, including ambulance presentations, and the clinical acuity of those presentations, this target is often difficult to achieve.

The delay in the diagnosis of your appendicitis understandably caused you distress, therefore it is important to us that we investigate all the details of your presentation to obtain an understanding of what happened and to identify if there were things that we could have done differently.

We would be grateful if you could contact our consumer liaison office on 08 9400 9672 or as we would like to obtain further details from you. Once we have completed our investigation, we would be happy to provide you with our feedback. You can discuss how you would like to receive this feedback, when you contact our consumer liaison office.

Thank you again for taking the trouble to contact us through Care Opinion.

Please accept our best wishes for your ongoing good health.

Yours sincerely

Paul Taylor-Byrne

Acting Deputy Director of Clinical Services

Joondalup Health Campus

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