"My admission to emergency"

Dear cycloneyk86,

You have clearly had a very frightening experience which, by the sounds of it, could have been managed better on our part, especially in terms of the way information was shared with, and requested from you.

A major part of your feedback does seem to be around the way we communicated with you, so I think it will help if I explain some of our processes to you to help you better understand what we expect to occur. Just keep in mind that without being able to review your medical records, the information provided is based on the assumption that you presented with cardiac-sounding chest pain.

Triage

Patients brought in by ambulance are triaged on arrival by a nurse. Triage is a process whereby patients are rated with an Australasian Triage Scale (ATS) score from 1 to 5, based on their presenting symptoms. An ATS 1 is allocated to those patients who need to be seen immediately.

Patients with chest pain are usually given a ATS 2 triage score, moved into a cubicle in the main ED, and would be seen by a doctor within 10 minutes of triage. This review would be undertaken by junior or senior clinician.

Testing, diagnosis and treatment

Once in a cubicle the nurse would perform an urgent assessment and an ECG, which is a tracing of the heart. The ECG would be shown to a senior clinician as soon as it has been printed for assessment. The senior clinician would as a priority decide if the ECG has criteria for a STEMI (acute myocardial infarct requiring emergency intervention) or not, and whether there are any other worrying features on the ECG. If a junior clinician has first seen the patient, they then discuss the case with a senior clinician to decide on appropriate management of the patient.

The clinician would always discuss their concerns regarding the presentation with the patient and explain the reason for the referral to the cardiology team. This explanation may involve discussing possible complications of myocardial infarction.

Risk assessment and discharge

Once reviewed by the cardiology team, they will do their own risk assessment of the case. They may agree that inpatient management is appropriate and the patient is admitted as planned. If the cardiology team feel that the patient is suitable for outpatient management, they may discharge the patient home. Sometimes the cardiology team may feel that the chest pain is not cardiac in nature and then may refer the patient on to a different specialty as appropriate.

Administration

When the patient first arrives in the cubicle a member of the clerical staff does need to speak to them relatively urgently to take their details. These details are necessary to expedite the admission process if admission is required and also to urgently print patient labels required for documentation and investigations.

Goals of patient care

With regard to someone asking you to make a will, I can only assume that a clinician had discussed Goals of Patient Care with you. In similar cases where there is risk of cardiac arrest, it is important, where appropriate, that the doctor has a conversation with you about what treatments would be appropriate and acceptable to you if your condition deteriorates while you are in hospital. This also gives you the opportunity to ask questions and hear the opinion of your treating clinician.

Steps moving forward

I hope this information answers your questions. Our goal is to always provide exemplary care to our patients so I am glad you have posted your story as this has given us a different perspective through which to look at our communication at the point of care.

If you would like the hospital to review your medical records and the treatment you received please contact the Consumer Liaison Team on 08 9400 9672 or email consumerliaison.jhc@ramsayhealth.com.au.

Please accept my best wishes for your future health.

Yours sincerely,

Dr Kevin Hartley

Director of Medical Services

Joondalup Health Campus