"Being discharged before I was ready and left in a life threatening situation"

About: Austin Hospital / Emergency Department The Alfred

(as the patient),

I was a patient on a respiratory ward at the Alfred Hospital. I presented with an infective exacerbation of severe brittle asthma.

During the admission, I had to raise my concerns with the nursing staff that when the medical team did their round at the bedside, that there were a number of times that the medical staff spoke with me briefly and then walked outside the room and spoke amongst themselves about any changes in management that might take place with my care. I was then only to find out hours later of a medication change by the nurse who was caring for me at the time.

I asked the nursing staff to remind the doctors that I am a patient who has the right to person-centred care. Any decisions to be made about my care are to be discussed with me and ask for my consent. There were at many times a lack of transparency in discussion until I raised my concerns. Only then did the medical staff include me.

During my admission I was seen by the respiratory team in the afternoon with the consultant, registrar and resident. I participated in a walking test and was able to walk around the ward without a significant drop in oxygen saturation. I was slightly short of breath from the effort of walking, however recovered reasonably quickly. We discussed my discharge and it was decided that I would be discharged by a particular date.

During the early hours of the morning of the day I was for discharge, I had an episode of shortness of breath and tightness in the chest. I notified the night nursing staff. They eventually called the covering doctor overnight for a review. The nursing staff did not take my vital observations such as oxygen saturation. I indicated for them to do this. I couldn’t talk in a sentence to let them know properly that my condition had changed and that I needed assistance.

At approximately 8:00 am that morning. I pressed the nurse call bell. I remember it taking over 25 minutes for a nurse to attend to me. My condition had deteriorated further. A nurse eventually came and started to observe vital signs and see how I might require assistance.

During this time, the covering respiratory registrar for the day, in my opinion, burst into the room with the covering resident. The registrar introduced himself. He asked me how I was. I replied that I felt like crap and had a difficult night. He totally dismissed what I had said and he told me that I was for discharge that day. I tried to explain to him that my condition had changed. I live in country Victoria and if I was sent home that I would most likely require an ambulance straight back again. This did not appear to be any concern and he iterated that if that is what needed to happen then I could come back (or something to that effect).

He had a listen to my chest and reported that he could not hear any wheezing. It is well documented by my respiratory physician, from a different hospital, on my emergency information that I often present with a silent chest and no wheeze. This time, indeed I had no wheeze. This was not taken into consideration, nor is it the first time that doctors have made that mistake when assessing me.

He then indicated that he wanted to see me get up and walk down the corridor. I let him know that I was becoming short of breath on exertion to the bathroom. I stood up and walked the distance of about 4 rooms down the corridor. My effort of breathing was increased and I needed to get back to the room and sit on the edge of the bed. They did not check my oxygen saturation. Only the day before I was able to walk the whole ward without struggling with shortness of breath.

I returned to the bedside with the doctors and the nurse who was attending. The registrar indicated that I was fine and that I was walking just fine and that I was for discharge. I strongly advocated for myself, having difficulty trying to find the right words that I needed to say, and be able to string a full sentence together due to shortness of breath. The registrar said the consultant had spoken with him the day before and that I was to go home and that was the end of it (not the exact words, but to that effect). The matter was then dismissed. The doctors left the room and I was left wondering what the hell I was going to do. I did not feel that I was in a fit state to be discharged that day and that my condition needed reviewing.

I tried to self-advocate and given that I was oxygen deprived and so short of breath, I could not find the words that I needed to say to convince the medical team that I required their help, nor did I have the breath I needed to utter the words in full sentences. I feel I was treated less favourably and just totally disregarded and dismissed when I genuinely needed help.

The nurse said to me, so what are you going to do? I felt like I had no one to turn to. I felt like I had no alternative but to leave. I had my assistance dog that needed to be toileted downstairs in the courtyard. I had all my belongings to carry as well. My husband was over one hour and thirty minutes away to come and pick me up. My vehicle was parked near the city, but I was in no fit state to be driving myself.

I was confused, anxious, short of breath. I tried to call a friend and family to assist me, however I could not get hold of anyone to assist me and speak with the staff on the ward on my behalf. I then took my belongings and my assistance dog and walked slowly to the ground floor to toilet the dog. It was an effort and struggle with shortness of breath to walk that distance.

I sat and tried to capture my breath. I had been using my asthma reliever medications through a spacer since the early hours of the morning, to try and get some kind of relief from the shortness of breath and chest tightness.

I rang a family member who was at home and was to try and get myself by a taxi to their home. I would be able to rest there until another family member was able to pick up my car from the city and drive me home in the car and for them to catch the train back to the city afterwards.

I went for the taxi ride. During that taxi ride, the driver was most concerned about my current condition, as I began to deteriorate during the taxi ride. The driver insisted on getting me to the Austin Hospital, the closest facility.

The taxi driver assisted me to the triage desk in the Emergency Department. I was taken to a resuscitation area, triaged as a category 2 patient. Upon reaching the Emergency Department, my oxygen saturation was 82% on room air. I was reviewed by the ICU team and admitted under the care of the respiratory unit at the Austin Hospital. I was then admitted for 6 days. I never had any issues under the care of the Austin Hospital.

I am deeply concerned by not being taken seriously, dismissed and disregarded by the medical team when I was forced to be discharged from the Alfred, thus placing me in a life threatening situation with an exacerbation of my asthmar. I believe I was treated less favourably and I should never have been placed in this precarious predicament. I wish to bring this to your immediate attention, expect an explanation and a formal apology and a promise that I will be treated with the dignity and respect that every patient who is cared for at the Alfred Hospital deserves.

Staff attitude

Staff attitude


Responses

Response from Sue Palmer, Client Liaison Officer, Patient Opinion Australia

The following response has been published by Patient Opinion Australia on behalf of The Alfred Hospital.

Dear Concerned Citizen

I was concerned to hear about your recent experience and we have since reviewed the care you received. I hope the discussion you had and the information we have since been able to provide you with, has helped address your concerns. Your experience is not in keeping with what patients should expect when they visit our hospital, and I am sorry you felt you could not make yourself heard. Your feedback will inform and improve future care. If you have any further questions or concerns, please don’t hesitate to get in touch with our Patient Liaison team directly.

Kind regards

Keren Day

Patient Liaison Office Manager

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