"Not being kept informed of health condition"

Presented to Joondalup Health Campus emergency department recently, presentation young female nearing second trimester, suffering from 3 days of increasing vomiting and nausea episodes, unable to keep food or water down, slight upper right abdomen pain radiating to sides and central abdo. Previous 24 hours has about 20 vomits.

Aware this was going to be low priority as a triage however required iv hydration due to decreased urine output and help with vomiting.

Waited 6 hours in the waiting room, which we knew would be a significant wait time and were content to wait. On arrival to the department at 11pm line was inserted and bloods drawn, iv hydration started, Bsl 4.4. There was a nurse practitioner on duty on that pod who prescribed antiseptics and fluids, pt not medically seen by the nurse practitioner at this time.

Observations carried out regularly overnight, bsl did drop to 4.0 at about half past 3 -4 am the RN was concerned this would drop further as there was no oral intake being tolerated, pt asked to drink apple juice which raised the bsl to a higher level, pt vomited within 20 mins.

Bsl never checked again after this incident, despite nil oral intake until 12 pm and continued vomiting.

No doctor presented until staff were questioned about a plan at 4 am, 11 hours post presentation, excuse made was pt and pt’s parent no understanding the triage levels and that a doctor did not need to present in a timely manner for a cat 4 .

A doctor was contacted and arrived within minutes, did an examination and contacted obs and gynae who attended and reviewed pt quickly. At no point was the patient’s blood results discussed with the patient during either of these Consults.

More bloods taken at 5 am and pt sent for abdo US and pregnancy viability scan at 1030.

From 11 am staff informed pt that obs and gynae would come and review soon.

However other than nursing staff attending to observations no further medical review or update on pt health or results were provided until almost 7pm when the RN mentioned raised CRP. At no point during the day was the pt led to believe there was a possible infection, no investigation was commenced to find a source of infection, US results at this point have not been discussed.

Multiple attempts by various members of ED staff made to try and at least get a plan or have obs and gynae attend to discuss a plan of action with the pt.

At this point trust that the pt best interest are being looked after it had been decided to DAMA and go to another hospital for follow up.

Bloods results given on discharge, showed raised multiple deranged blood works.

Our concern is how you have a pt in your hospital for 27 hours, do not once have a conversation about the pt health with the pt, do not investigate abnormal results

I feel it is easy to seemingly blame staff shortage and acuity in the hospital but a single conversation with a plan of action puts your pt at ease that they are being looked after and their best interests are being put into some level of priority.