Case description in response to a complaint
04-07-2023 -by Elke Koestering – quality officer
The patient wanted to make an appointment in connection with pain in the neck, back and ribs, where it felt as 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, the patient was considered non-urgent after triage and was therefore not seen. However, tramadol was prescribed for the pain.
The next day, Mrs. called 112 because she still didn’t feel well. Complaints were shortness of breath, dizziness, pain and not being able 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 planned. The visiting doctor suspected a pulmonary embolism and referred the patient to the hospital by ambulance. In the hospital, it turned out that a pulmonary embolism was indeed found; The blood clots turned out to be in front of the right ventricle. This resulted in 2 days of ICU admission and invasive treatment.
Takeaway
The use of DOAC (blood thinner) was mentioned by the GP in the LSP. The GP took this into account in the consideration. But couldn’t the use of DOAC also be a trigger to consider the formation of blood clots? Therapy compliance is important, when asked by the visiting doctor, it turned out to be moderate. 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 arrived at. In this case, it would have been seen that the degree of shortness of breath had been set to “not”. The learning point is not that every pulmonary embolism must be ‘caught’ in telephone triage. What we do know is that 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
- Better questioning triage nurses if contextually unclear or something seems illogical.
- Consider taking over the conversation with the patient.
- Inquiring about the patient’s compliance with the medication that is already known
- Meticulously go through the triage tab. Preferably standard, but especially if there are questions regarding the above points.
- High back pain in combination with shortness of breath is easily assessed.