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Stories can lead to change

Your health care experiences reveal authentic patient priorities, including

  • Where health care design or delivery could be improved
  • What constitutes patient and family-centred care
  • Ways to improve the patient experience
 
January 2014
Accountability in the emergency department
Jan 17, 2014 11:01 AM

I had been on my sailboat for the summer in Georgian Bay/North Channel and had not been well before I left as I had some difficulty swallowing. I live with Multiple Sclerosis. I attributed the swallowing difficulties to that. I was drinking only instant breakfast drinks, not eating.

Over the summer I was urinating a lot and having "accidents" but I attributed that to interstitial cystitis, another autoimmune disease I have. I was getting worse and had lost a lot of weight so we went home and I saw my doctor. He had blood work done and said he would call with results. When he called he said my blood glucose level was very high and that I should go to the hospital. He called the emergency room to say that I was coming.

When I was seen by a doctor, she had an IV started, as I was dehydrated, and gave me 10 units of insulin. When the IV was finished she discharged me and said to go and buy a glucose meter. There was no follow up plan and I was too unwell to advocate for myself. My husband questioned them but he was not familiar with medical protocols and so he took me home.

By the next morning my blood glucose was even higher and I was becoming incoherent and unable to think. My husband called the emergency room and was told to take me back. For the next 48 hours I was in the cardiac unit as I was in diabetic ketoacidosis (DKA) a critical life-threatening condition. The objective was to bring my blood sugar and ketones back to normal range without causing cardiac arrest.

Once I was out of DKA I was seen by an endocrinologist who started me on medication for diabetes. I had frequent blood tests and medications were changed and added to until it was obvious that they were not working. I was then given a prescription for insulin. I was taught how to administer it and was discharged for follow up by an endocrinologist in the community.

When I was well enough I wrote a letter to the CEO of the hospital, the chairman of the hospital board of directors, and the chief of staff. I did hear from a person assigned to respond to complaints, with apologies and regrets about what happened. I insisted on it in writing, signed by the CEO, which I received.

This example shows how vulnerable we can be when we go to the emergency room. I think that there should be some accountability in the emergency room. Was their protocol at fault, or was their protocol not followed? The outcome could have been fatal!

What we learned:

1. The ED treats people in isolation of the patient history or a follow up plan
2. ER treatment must be integrated into the patient’s history and go-forward care plan
3. The ED people are not trained to deal with or concerned with patient anxiety

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