Case description of the breakaway leads to the NTS adjustment

18-01-2022 -

by Marry Witteman – case manager Regional Investigative Committee

A 72-year-old man (late) calls the post via the emergency line around half past six, at the end of the afternoon. The gentleman went out for a few minutes but had regained consciousness. Triage nurse asks patient on the line and does a 1st triage. Gentleman says he is now feeling well again. As a result, it is agreed that the patient will be called back and the triage will be done again so that the emergency line does not remain occupied.
A little later, the triage nurse calls back to a patient who had received chemotherapy in the past week. The gentleman is feeling well again and actually wants to go for a walk. There is another triage and self-care advice with a safety net is the end result. In addition, it is agreed that the gentleman will also contact the attending physician of the hospital.
At seven o’clock that evening, the LUMC emergency department calls and reports the death of this patient.

With such a development and the phone call from the Emergency Department, healthcare workers are usually frightened. What did we miss and what happened? These are questions that can immediately become embedded in the minds of employees. The investigative committee investigated this case on behalf of the management of De LIMES. Such an investigation – in which every moment of contact and every appointment is meticulously peeled back – helps to clarify the context of an event to a large extent. Sometimes one has to conclude that outcomes are inescapable. The cause of death of this patient was ultimately massive pulmonary embolisms. Nevertheless, this case still gave room to tighten up the system.

In the first place, the idea is to keep patients who call at the emergency line in the system and not call them back again. This method has already been adapted as a result of another case. Calls that do not appear to belong on the emergency line are now put back in the queue. Incidentally, there were special circumstances in this case because the patient and his partner did not have a telephone with them. 

The entry complaint at the triage was ‘collapse’ or snatch. No questions were asked about what preceded it. During the investigation, the members of the investigative committee asked the question of what the run-up to the rape had been like. Was it acute? What was sir doing when it happened? With answers to these questions, more information about the nature of the collapse may become available. Could the NTS (Dutch Triage System) offer more support in this with triage? Through the chairman of the committee, this point (Acute beginning) was submitted to the editorial board of the NTS. Below is the response of the editorial board:

Decision of the Editorial Board:
In the [TC] support questions, add “Acute Onset”: What did you feel before you left? What complaints did you have before you left?
Motivation: With a more extensive assessment of the cause of the stroke, the triage nurse becomes more aware of the possible severity of the stroke.

As a result of this case, the NTS will be adjusted. The committee is pleased that this adjustment makes working safer for all triage nurses. This will be realized with the new release of the NTS.

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