Case description in response to a complaint
04-07-2023 -by Elke Koestering – quality officer
Patient wanted to make an appointment because of pain in the neck, back and ribs, where it felt if the ribs were bruised. There was also shortness of breath, but the lady herself indicated that she was an asthma patient and that it was therefore difficult to assess.
At the HAP, after triage, the patient was considered non-urgent and was therefore not seen. However, tramadol was prescribed for the pain.
The next day, Mrs. 112 called because she still wasn’t feeling well. Symptoms included shortness of breath, dizziness, pain and inability to sit, lie down, stand and walk. The control room did not consider the complaints urgent at that time and transferred the patient to the HAP. After triage, a U3 visit was scheduled. The visiting doctor suspected a pulmonary embolism and referred the patient to the hospital by ambulance. In the hospital it turned out that there was indeed a pulmonary embolism; The blood clots turned out to be in front of the right ventricle. This resulted in 2 days of ICU admission and invasive treatment.
Learning point
The use of DOAC (blood thinner) was mentioned by the GP in the LSP. The GP took this into account. But couldn’t the use of DOAC also be a trigger to consider the formation of blood clots? Adherence to therapy is important, when asked by the visiting doctor, it turned out to be mediocre. Consulting the LSP does show its added value in that this information was at least known. It is also important that the GP consults the triage sheet when authorising the contact and, if necessary, questions the triage nurse to assess how an urgency was reached. In this case, it would have been seen that the degree of shortness of breath was set to “not”. The lesson learned is not that every pulmonary embolism should be ‘catchable’ by telephone triage. However, with careful triage, you are sometimes put on a track that can lead to earlier diagnosis and treatment.
Tips and tops
TOP
- consulting LSP
TIPS
- It is better to question a triage nurse if contextually unclear or something seems illogical.
- Consider taking over the conversation with the patient.
- Enquiring about the patient’s adherence to the already known medication
- Carefully go through the triage tab. Preferably standard, but especially if there are questions in response to the above points.
- High back pain in combination with shortness of breath can be assessed in an accessible way.