Negligent Emergency Room Triage Leads To Fatality Due To Stroke

Case Overview

This case involves a 68-year-old male patient with a history of heart problems who arrived at the emergency department with symptoms of a stroke. At the time of admission, the patient was 2 hours into the 5-hour window treatment from his last known normal. The patient expected to receive tissue plasminogen activator (tPA) treatment, however, he was never given tPA. Over the course of 4 hours in the emergency room, the emergency room nurse did not conduct an evaluation of the patient’s last known normal or connect the patient with a neurology consult. After 4 hours of no treatment, the patient coded and passed away. It was alleged the emergency room nurse did not correctly triage the patient.

Questions to the Nursing expert and their responses

What is the triage protocol in an ED?

I have frequent occasion to follow the American Heart/Stroke Association algorithm for the nursing assessment of the patient with signs of stroke using an appropriate stroke scale within 10 minutes of arrival and ensuring the patient undergoes a CT scan to rule out intracerebral hemorrhage.

What is the nurse's responsibility for ensuring the doctor sees the patient in a timely manner?

The physician is required to assess the patient within the initial 10 minutes during which the patient is undergoing intervention to ensure the stability of airway, breathing, circulation and blood sugar.

What is the chain of command if the doctor does not meet his responsibility?

If the physician refuses or is somehow unavailable to evaluate or treat the patient, then the nurse has a duty to access her chain of command. The first being the charge nurse, next the house supervisor, and, if necessary, the medical director.

About the expert

This registered nurse expert has a BS from Camosun College, Canada and an ADN from Douglas College, School of Nursing, Canada, as well as 25 years of experience. She is a certified Advanced Cardiac Life Support provider as well as a Certified Emergency Nurse. She has also completed a three year course in Advanced Trauma Nursing and was formerly an Emergency Room Nurse at Baptist Emergency Hospitals. Currently, she is a Registered Nurse II with a major healthcare network. She has extensive experience caring for post-operative patients.