Sometimes people race to Emergency Departments... only to end up waiting for hours

A fifty year old woman we will call 'Alisha' woke up with visual disturbances, a headache and confusion.

She had seen the ads on television, saying ‘if you feel you are having a stroke, go straight to the emergency department’.

Alisha had even read about the Stroke acronym called FAST - Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services

Alisha picked up her phone and called an ambulance. It came right away and was whisked to the nearest Emergency Department within in half an hour. Alisha also called her two daughters, who rushed to the hospital to be with their mother.

Alisha explained all of her symptoms to the ambulance officers. They passed this information on the the triage nurse.

She was taken into a small cubical in the Emergency Department, changed into a white gown with ties at the back and given a set of neurological observations.

At first her blood pressure, pulse, respiratory rate and temperature was taken.

Then a pen torch was shone in her eyes to monitor her pupil constriction.

Alisha was asked "What's your name, how old are you, where are you now?"

The nurse held her hands saying 'push against me, pulling my hands towards you".

Finally the nurses hands were pushed down on Alisha's legs and she was told "lift your legs up against me".

The nurse wrote the results on a piece of paper that she filed in a manilla folder. Then she rushed off.

Alisha waited. And waited. And waited.

A junior doctor came to see her, ordered an ECG, then rushed off again.

Emergency was busy that morning. Nurses and doctors were rushing past dealing with new admissions.

Finally Alisha was taken radiology, for a CT of her brain. This scan would tell Doctors if Alisha had experienced a bleed in her brain or not.

There are two types of stroke, a bleed from a burst blood vessel and a clot causing ischaemia, or lack of blood flow to part of the brain.

If people have not had a bleed, then they might have an ischaemic stroke. An ischaemic stroke is more common, and diagnosis depends more on the patients symptoms.

Five hours later, after numerous observations, one set of bloods, an ECG and a CT brain scan of her brain, the Doctors finally go around to diagnosing Alisha as having had an ischaemic stroke.

This meant a clot that might have originated in her heart had moved to one of the blood vessels in her brain. The reason for her symptoms what that the clot had blocked off blood supply to a part of her brain.

But by now it was too late for Alisha the standard treatment for an ischaemic stroke, known as clot busting drugs or Tissue Plasma Activator.

The Emergency doctor explained that the clot busting drugs can only be given within four hours of a stroke occurring.

“But I’ve been waiting here for five hours” cried Alisha. “I told the nurse at reception that I was having a stroke. I’ve seen the symptoms on the TV. Why didn’t anyone see me sooner?”

The daughter's joined in with their mothers complaints.

Their mother had waited patiently, as she had been told to do, for a Doctor to see her and organise treatment.

The Emergency Department Doctor apologised.

Alisha was admitted to a stroke ward in the hospital.

A neurologist came to see her on the ward the next day.

He told her that she had missed out on very important treatment. He also expressed his frustration about the mixup up in the Emergency Department, that had deprived her of life saving treatment.

The only treatment that Alisha was now able to receive, was to be put on a blood thinning tablet.

The next day she was then discharged home.

The following week, Alisha suffered another stroke.

The ambulance was called again, and she was readmitted to the same Emergency Department.

This time she was very distressed and angry.

"Nobody cares" she cried out."I came here two days ago and you just left me without any treatment.

More observations and scans were done. Alisha was finally taken up to the same ward. But her trust in the hospital system was gone.

She was angry, suspicious and refused to have another CT of her brain. Instead she rang her daughters again.

"Take me home" she told her daughters. "I don't trust these people".

This incident was not recorded as an error. The Emergency Department did not review and change their stroke treatment procedures.

Wikihospitals 2014

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