Winnipeg Free Press - PRINT EDITION

Discharge measures 'appropriate'

But deaths of two patients spur more rigorous process

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An internal review into the deaths of two men sent home by cab from Grace Hospital has found no deficiencies in how each were treated and assessed before being discharged.

"The medical assessments were deemed appropriate," said Arlene Wilgosh, president and CEO of the Winnipeg Regional Health Authority. "These gentlemen were deemed competent and the discharges were deemed appropriate."

She said both had underlying medical conditions that caused their sudden deaths.

"If you have an underlying condition that could predispose you to sudden death, you can't predict when that is going to happen," Wilgosh said. "Sudden death by its definition is sudden death."

A more rigorous emergency department discharge process, at times involving cab drivers, will be developed by health-care officials in the wake of the deaths of the two men discharged from the Grace.

The regional emergency department checklist will augment the WRHA's safe patient discharge guidelines.

For patients being sent home by taxi, drivers will be given specific instructions if the patients need help getting inside their residence.

The measures were outlined Thursday by Wilgosh and Lori Lamont, vice-president of inter-professional practice and chief nursing officer.

The changes are in response to the deaths of two men who were discharged from the Grace but died after leaving their taxis.

Wayne Miller, 62, was discharged from the Grace at about 8:25 a.m. Dec. 29 and driven home by taxi. At about 9 a.m., residents in the 100 block of Arlington Street discovered the man lying unresponsive on the sidewalk. He suffered an aneurysm and died.

On Dec. 31, David Silver, 78, died after being dropped off at home by a cab at about 1:30 a.m. while wearing a coat over his pyjamas and bedroom slippers. He had just been discharged from the Grace Hospital emergency room, where he was diagnosed with kidney stones and gallstones and told to see his family doctor. He had a heart attack moments after the cab pulled away. His housekeeper found him later that day lying a short distance from his front door.

Wilgosh said Silver, when he left the Grace, was "very much in control" but Miller did require assistance.

Wilgosh said the two incidents show the WRHA has to enhance its ER patient discharge process.

She said the health authority will pilot a regional emergency department checklist with the purpose of making sure its safe patient discharge guidelines are followed. Those guidelines were brought in following the Jan. 28, 2012, death of Heather Brenan, who was sent home in a taxi from Seven Oaks General Hospital and collapsed at her front door. Brenan's death will be the subject of an upcoming provincial inquest.

"The checklist is meant to be a one-page (form) that says, 'Have you talked to the patient about do they have their keys? Is there somebody at home? Do they wish that person to be contacted?' Wilgosh said.

It will also allow the WRHA to monitor whether the discharge guidelines are being followed.

"It will become part of the patient record," Wilgosh said.

Silver's nephew, Miles Pollock, said he appreciates the WRHA is taking action as quickly as it is.

"I love the fact they've done positive things," he said. "Maybe it's my uncle's legacy. I hope so."

However, Pollock said the WRHA must give more serious thought to releasing patients in sub-zero temperatures at night and perhaps allow them to stay in the ER until the morning, when alternate arrangements can be made.

"I think you have to think about those environmental factors and they don't seem to cover that," Pollock said.

Wilgosh said the health authority, in consultation with the taxicab industry, will also enlist the help of cab drivers to make sure a discharged patients gets home safely. For example, it will see drivers being given instructions the patient needs help to the front door and inside their residence.

"The taxi driver will come into the emergency (department) and there will be that communication, and we will also ensure that the discussion between the cab driver and the health-care provider, that that information is also shared with the patient so that all three parties are actually clear what the plan is for the safe trip home," Lamont said.

Wilgosh added for some patients in which warm clothing is an issue, a stretcher service will take them home.

In the last fiscal year, the WRHA spent more that $84,000 in taxi-transportation costs in sending patients home.

Republished from the Winnipeg Free Press print edition February 14, 2014 A4

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