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.
Question(s) For Expert Witness
- 1. What is the triage protocol in an ED?
- 2. What is the nurse's responsibility for ensuring the doctor sees the patient in a timely manner?
- 3. What is the chain of command if the doctor does not meet his responsibility?
Expert Witness Response E-006392
I am a staff and charge nurse in a busy primary stroke center. As such, I am familiar with the standard of care as set by several regulatory and professional bodies regarding the rapid triage of the patient with potential stroke. Specifically, 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. I am familiar with the standard of care regarding when to call a stroke alert and to fast-track a patient to receive or be excluded from the administration of TPA. 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. 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.