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Management of head injury (07HDC10767)
Download Management of head injury (07HDC10767) (PDF 164Kb)
(07HDC10767, 25 September 2008)
Emergency medicine specialist ~ Senior house officer ~
Public hospital ~ District health board ~ Emergency department ~
Brain injury ~ Headaches ~ Standard of care ~ Rights 4(2),
A 67-year-old man was transported by ambulance to an emergency
department shortly after being assaulted. He was initially attended
to by an emergency medicine specialist, who ordered X-rays of the
man's face before his shift ended. A senior house officer examined
the X-ray and noted that the man had a fractured nose, cheek and
suspected eye socket fracture. She discharged him home with an
appointment to return to an outpatient clinic six days later. At
the clinic appointment his facial fractures were confirmed by CT
scan. A month later, when his headaches had not resolved and he had
some hearing loss, his general practitioner referred him back to
the clinic for an urgent appointment. He was prescribed
decongestant spray for sinusitis, and an ENT appointment was
arranged for an assessment of his hearing problem.
The following day, the man returned to the emergency department
with his family and was attended by the senior house officer. The
man had suffered ongoing headaches since the assault, and was vague
with some memory impairment. When his headache responded to
analgesia, the senior house officer discharged him into the care of
his family and general practitioner. The next day the man returned
to the emergency department. A CT scan of his head revealed a
subdural haematoma, and he was immediately transferred to another
public hospital for burr hole evacuation of the clot.
It was held that the emergency medicine specialist did not meet
professional standards of care and documentation in his assessment
of the man, and breached Right 4(2); overcrowding and staff
shortages did not excuse this.
The senior house officer was held to have provided a standard of
care that was appropriate for a doctor of her experience, and thus
did not breach the Code.
The manual whiteboard system used for handover in the emergency
department at that time was incomplete, and did not ensure accurate
and thorough handover of patient care between shifts. It allowed
the man to "fall through the cracks", and significantly contributed
to the emergency department consultant's failure to hand over the
man's care to the senior house officer. In these circumstances, the
DHB breached Right 4(5) by failing to ensure continuity of care.
The failure of the Radiology and Plastics Departments to have
robust processes in place for reporting to GPs also constituted a
breach of Right 4(5) by the DHB.
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