Hospital sorry over missed meningitis case

18:09, Aug 18 2014

Delays in diagnosing a young Wellington woman's meningitis put her at risk, and were the result of a series of "systemic and individual failures", a report has found.

The woman arrived at Wellington Hospital's emergency department in August 2012, complaining of a sore throat, stiff neck, headache and vomiting. A classmate had been diagnosed with meningococcal meningitis 10 days earlier.

After 30 minutes, she was assessed by a triage nurse, and waited more than three hours to be seen by a doctor.

She was diagnosed by a senior registrar as having pharyngitis and was discharged the next morning, after receiving intravenous antibiotics overnight.

But she returned to ED after developing a rash on her hands and legs. She waited almost an hour to see a doctor, before being admitted with a primary diagnosis of meningococcal meningitis and septicaemia, and a secondary diagnosis of group A streptococcal throat infection. She had five days of intravenous antibiotics before being discharged.

Health and Disability Commissioner Anthony Hill, in a report published yesterday, found Capital & Coast DHB to have breached the Code of Health and Disability Services Consumers' Rights. He said a series of systemic and individual failures led to delays in the medical assessment on both visits to the ED, which were suboptimal in the circumstances. Hill held that, by failing to provide adequate staffing and resources to enable its triage procedures to be implemented effectively and safely, the DHB failed to provide services in a manner that minimised the potential harm to her.

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He was critical of the triage nurse, and of the registrar's decision to send the woman home without discussing her case with a more senior colleague.

He recommended CCDHB review its triage policy and audit the changes made since the incident.

Deputy chief medical officer Grant Pidgeon said the DHB accepted the commissioner's findings, and acknowledged the systems it had in place at that time were insufficient to cope with demand, which contributed to the delayed assessment. "We have written an apology to Miss A and wish to apologise again for any distress caused by the delays to treatment she received."

Since the incident, a staffing in ED had been increased, and additional symptoms training had been provided.

Overnight discharges now had to be reviewed by a specialist during the morning shift handover, and a room-to-room handover between specialists took place during every shift.

The Dominion Post