When an overloaded ED gets it wrong, who should be accountable?

Chalongrat Chuvaree/Getty Images At this time of year, crowded hospital emergency departments are a familiar sight around New Zealand.

It’s also a symptom of a health system under intense pressure.

For patients, it means long waiting times to see a doctor.

But for clinicians balancing workforce shortages with rising demand, it can mean making increasingly difficult decisions in far from ideal circumstances.

Such pressures, which can raise the risk of clinical error, have prompted the New Zealand Nurses Organisation to campaign for enforceable safe staffing levels .

A recently released finding from the Health and Disability Commission (HDC) provides an unfortunate example.

It involved a 55-year-old man who presented to an ED – at the time operating at 200% occupancy and ten nurses short – with burning central chest pain.

The triage nurse assessed the pain as non-cardiac and assigned a triage score requiring assessment within 30 minutes.

But an ECG was not performed until four-and-a-half hours later, when it confirmed he was having a heart attack, before being urgently referred to the hospital’s cardiac team.

Health NZ’s subsequent adverse event review concluded the patient should have been assigned a more urgent triage category.

Its recommendations included more education for triage nurses, escalation procedures for when ED capacity becomes critical, increased staffing and a waiting-room nurse.

“"Next paragraph rearranged”“ The HDC investigation found Health NZ had breached the Code of Health and Disability Services Consumers’ Rights .Its findings, reported in national news media however, reached a different emphasis.

While acknowledging hindsight bias and pressure on nursing resources, it focused on the failure to recognise the patient’s symptoms as cardiac, assign the correct triage score and ensure timely assessment.

Clearly, the patient should not have waited that long for treatment.