RN at telehealth service breaches the Code for secondary triage following emergency call - 20HDC00862

In a report released today, Deputy Health and Disability Commissioner Rose Wall has found a registered nurse at a telehealth service breached the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to provide services of an appropriate standard to a woman in her seventies.

The woman had been ill for three days with vomiting symptoms and abdominal pain when her friend called emergency services. The intial call handler advised that the woman was not in immediate danger and a registered nurse or paramedic would call back within 30 minutes to undertake a secondary triage.

The secondary triage was completed by a registered nurse who advised the woman to see her GP the following morning. The GP diagnosed an upper gastro-intestinal bleed and called for an urgent ambulance transfer. Sadly, the woman died at hospital later that day from sepsis and a bowel obstruction, secondary to a hernia.

Ms Wall found the registered nurse who provided the secondary triage breached the Code for failing to provide services of an appropriate standard | tautikanga.

"In my view the information the nurse gained in the secondary assessment should have highlighted the need for timely consultation with a clinician," said Ms Wall.

In the report Ms Wall said risk factors were not taken into account when making decisions regarding the urgency of the woman’s need for medical assessment and her face to face assesment. These risk factors included the woman’s age, the length of time she’d been sick and her medical history.

The risk factors, "were not given enough consideration; nor was the fact that the recommendation from the triage tool was to be seen within six hours, which would have been very difficult to achieve without paramedics being sent," said Ms Wall.

Ms Wall also made an adverse comment about the telehealth service in relation to the algorithm decision tools and protocols. However, she accepted that the triage tool system as a decision-making tool is conditional on the accuracy of the information entered.

Since this event, the registered nurse, the telehealth service and the ambulance service have made a number of improvements, which are outlined in the report. Taking into account the changes made Ms Wall outlined several further recommendations for the telehealth service.