The case in summary Ukom has received over 300 notifications of serious adverse events at the emergency room since 2019. A new report from Ukom criticizes the emergency room for not always picking up the degree of severity when patients call repeatedly. The report includes an incident where a pregnant woman in her 20s died after contacting the emergency room several times without getting the necessary help. Among other things, Ukom recommends better communication skills and the use of video consultation to better assess the patients’ condition. Ukom directs its recommendations to the Ministry of Health and Care, the Directorate of Health and the professional environment. The summary is made by an AI service from OpenAi. The content is quality assured by news’s journalists before publication. Since its inception in 2019, Ukom has received over 300 notifications of serious adverse events in the emergency department. In a new report, they criticize the emergency room. They investigate why the emergency service does not always pick up the degree of severity when patients call repeatedly. The report tells of a woman in her 20s who was nine months pregnant and expecting her second child with her partner. The woman had flu symptoms and a cough. The roommate was on a work trip and the woman’s mother stayed with them to help with the grandchild. Emergency room in Oslo. Photo: NTB Worse and worse form She told the emergency center about pain in her shoulders at night and that she had pain down her back. The day before, she had taken a rapid test for covid-19, which was negative. She made an appointment for an examination with a substitute GP where she was diagnosed with a muscle injury in the shoulder. After this, the mother told the woman that her daughter developed a violent cough, seemed more relaxed and could not take much food and drink. She got sicker and sicker. Found dead in the room The woman tried the morning after to get in touch with the substitute GP, without success. In the evening, she tried to call the emergency call centre, but did not get through. She then called AMK. They considered that there was no need to send an ambulance and transferred the phone to the emergency call centre. At the emergency centre, she was transferred once again. Now to a respiratory doctor who concluded that the woman had no breathing difficulties during the conversation. As the woman and her mother were concerned, they had another doctor call her. Together, the woman and the doctor spoke for 17 minutes. There she was told that she had to get in touch again if her health deteriorated further. The mother says that her daughter coughed less when she was on the phone with AMK and the emergency room. During the conversations, she sat at the front of the chair with her stomach between her legs to put less pressure on her lungs during the conversations. The next morning, the mother found her daughter lifeless in bed. She was pronounced dead at the scene and the unborn child could not be saved. A rapid test for covid-19 was taken, which was now positive. – Good communication is important Synnøve Serigstad is head of relations and learning at Ukom. She says communication skills are, and will be, very important in the health service. – The public is asked to call the emergency room first. Then it is extra important that they have the skills to be able to detect serious cases over the phone, she says. Head of relationship and learning in Ukom (the State’s Commission for Health), Synnøve Serigstad. Photo: Ukom She also mentions video consultation as a possible help for the emergency centre. – Video makes it easier to see how the patient is doing. In the patient incident with the woman, it could have helped the emergency room to see that she was leaning forward on the chair with her stomach between her legs in order to be able to speak effortlessly, says Serigstad. “Get in touch in case of deterioration” is also a common term she believes should be specified. – It is difficult for the population to understand what is involved. Here you can rather say, “take two Paracet and wait half an hour. Call again if the fever has not gone down,” she says. Clear recommendations The recommendations are addressed to the Ministry of Health and Care, the Norwegian Directorate of Health and the professional environment. Scroll through all the recommendations Ukom has made: Competency requirements should be set for healthcare personnel Ukom recommends that the Norwegian Directorate of Health consider whether the National Guide for Emergency Services and Emergency Centers should require competency requirements in clinical communication for healthcare personnel. In addition, they will have a system for continuous follow-up of employees’ communication skills . Possibility of audio recording of telephone conversations Today, there is limited possibility for documentation and learning after telephone conversations between doctor and patient. Ukom recommends that it should be possible to record the telephone conversations so that it can be used for training and documentation. Development of decision support tools Decision support tools are used to help the patient make a decision in unclear issues. Ukom believes the Norwegian Directorate of Health should give the national professional communities a mandate for the work to further develop decision support tools. Video consultation Most emergency centers have access to video, but Ukom’s survey shows that use is limited and random. Ukom says there is reason to assume that the advantages of video can benefit more patients. Need to explain what the term deterioration means The survey shows that it can be difficult to explain what the term “get in touch in case of deterioration” means. Ukom recommends that the national professional communities work together to clarify what is included in the term. The advice should be sent via SMS Patients forget or misunderstand 40 to 80 per cent of the information they receive from healthcare personnel. It can improve patient safety to have repeated information that has been given. Ukom recommends that the Directorate of Health be commissioned to investigate digital solutions, such as sending the advice by SMS.
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Criticism of the emergency room after several serious incidents – news Rogaland – Local news, TV and radio
