Hey there, time traveller! This article was published 13/1/2014 (2804 days ago), so information in it may no longer be current.
Grace Hospital officials may have ignored an updated patient discharge policy when they released two elderly men last month. Both died a short time later after being sent home by taxicab.
The discharge guideline says in all cases, patients who require assistance with transportation or to get into their homes and remain there safely must have a named and available support person contacted, confirmed and documented by hospital staff before being discharged.
The Winnipeg Regional Health Authority's emergency program safe patient discharge guideline was brought in May 28, 2012, and updated the following November. It was put in place four months after 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 two elderly men who died last month were treated and released at the Grace Hospital within 24 hours of each other. Each was found dead outside in frigid late-December weather.
David Silver, 78, died Dec. 31 after being dropped off at home by a cab about 1:30 a.m. wearing a coat over his pyjamas and bedroom slippers. He had just been discharged from the Grace 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.
In the other recent death, a man in his late 50s or early 60s -- the WRHA would not confirm his name or age -- was discharged from the Grace about 8:25 a.m. Dec. 29. About 9 a.m., residents in the 100 block of Arlington Street discovered the man lying unresponsive on the sidewalk. The CBC identified him as Wayne Miller and reported he suffered an aneurysm.
Health Minister Erin Selby said Monday the WRHA is investigating the two recent deaths to determine whether the health authority's emergency program safe discharge policy was followed and whether the two men were "medically ready" to be released at a time the city was under a deep freeze.
"We're going to look at the entire circumstance," Selby said. "Maybe we have to talk about what the weather is like and what time of day they're going home and if there is going to be somebody there or if they're going home on their own."
The rookie minister went on the offensive Monday in an attempt to put more focus on the review of the two deaths and to distance herself from comments she made Friday that cab drivers would be given more responsibility to see discharged patients arrive home safely.
"We're just talking about formalizing what many of them are already doing -- an extra pair of eyes watching that person get to the front door," Selby said Monday.
Progressive Conservative health critic Myrna Driedger called Selby's comments on taxi drivers a sign of incompetence, suggesting Selby appeared unaware of Brenan's case.
"It made me think no wonder the health-care system is failing patients if this is the kind of thinking that's coming from a minister of health," Driedger said. "I think she's trivialized the seriousness of the situation. You've got people dying who are frail, vulnerable, elderly seniors."
"Part of what the critical incident review will look at is whether or not those safe discharge guidelines were followed and whether we need to strengthen them," Selby said. "When a doctor determines that somebody is healthy enough to go home, we also want to make sure that there's the support in place when they get there."
Also Monday, WRHA president and CEO Arlene Wilgosh met with two members of the Manitoba Taxicab Board -- chairman Bruce Buckley and Coun. Harvey Smith -- to begin looking at a new policy for cabbies who drive discharged patients home. More meetings are planned over the next few days.
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Smith said what's being considered, at this point, is that a driver who takes a patient home will stay outside a residence until the fare is inside.
"To me this has been blown out of all proportion," Smith said. "I think cab drivers should be able to go ahead and stay when they drop someone at their residence, especially when they're dropping someone off from a hospital. They should, in effect, be willing to wait a minute or so to see the person walk up to their door and into their house."
Smith, who uses taxi services several times a day, also said drivers should have no issue waiting.
"They do very little except go from Point A to Point B now," he said. "I think we should reward and encourage those cab drivers to wait until they see the passenger get inside their house. It's reasonable to me."
He said before anything is decided, he wants to know whether the WRHA's discharge policy was followed and whether the two men were in a condition to be released.
The WRHA's current safe patient discharge guideline has been in place since 2012. Here are some of its provisions:
If the patient consents, family members should be included in planning for discharge.
Extra caution should be used when patients have social problems, some form of disability or injury or any other issue that prevents them from looking after themselves.
Discharge orders are made in writing by an emergency room doctor or nurse practitioner after considering all available test results, the patient's ability to cope at home and if any further necessary hospital treatment can be done on an out-patient basis.
The patient's vital signs must be taken and documented within one hour of discharge and found to be acceptable and safe for discharge (this may not apply to patients treated for certain minor conditions).
"All significant safety concerns" raised by patients, families and others must be addressed before a patient is discharged.
"In all cases, patients who require assistance with transportation or to get into their homes and remain there safely must have a named and available support person contacted, confirmed and documented by the ED (emergency department) nurse or emergency physician/nurse practitioner before being discharged."