A front page news article today describes a situation where a lady presented to an Emergency Department in Melbourne with a “threatened and incomplete miscarriage” at 10 to 12 weeks.
Unfortunately for this lady, she miscarried the foetus into the waiting room toilets while waiting for medical r/v.
The story is extremely damning of the hospital involved, check out the title of the story: “Hospital shame as (patient) miscarries baby in toilet”
This story has brought a whole host of opinions out of the woodwork, and a common theme is absolute and utter disbelief by the public that “this sort of thing can happen in this day and age!”.
And so, some reflections:
Firstly, I’d like to throw in a disclaimer – this article is written by a health care professional for reading by other health care professionals – it is not intended to belittle or minimise the family’s loss.
Having said that, I’d like to suggest that any kind of PV spotting / bleeding at triage is a tricky situation.
- Often in fact, it does not rank very highly as a medical emergency. If the bleeding or spotting is minimal, and in particular if the person’s vitals are all stable, they might rank fairly low on the triage scale.
- Unfortunately, it ranks extremely highly on people’s emotional-meters, and members of the public often feel that any kind of PV spotting or bleeding in pregnancy should warrant an immediate medical team review, ushering of the patient straight through to acute cubes, and some kind of immediate treatment.
- The reality is that in the vast majority of cases, the patient’s life is not at risk. It’s not a life and death situation for the mother. And for the child? As harsh as this sounds, what is going to happen naturally at this point is pretty much unpreventable. The person might miscarriage, they might not. Getting the person in sooner or later is unlikely to change the inevitable.
And so, there’s often this perception that “the hospital let this poor mother sit in a waiting room and miscarry without doing anything about it!”.
I’ve had this discussion with members of the public before and have been cut down as being heartless and unsympathetic, but let me assure you that I am neither. I am a realist, and the reality is that although the situation is important to the person involved, it is hard enough getting people in to acute beds with really serious stuff, particularly when faced with the ever problematic situation of in-patients taking up acute emergency beds in the public system.
Despite all this, I always try to get any potential miscarriage into some kind of bed, even a corridored one to try and avoid what happened in this story, but this is for humane reasons more than anything else. It can be difficult to do this, particularly on busy shifts, and especially when the mother is 100% stable. It’s impossible to predict which ones will progress to miscarriage, particularly when bleeding is light.
When do we Hurry Things Up?
The situation is always escalated if there’s any element of danger – if the bleeding is really heavy for instance, if the patient is symptomatic in any way (ie light-headed, dizzy etc), or if they are hypotensive. Any patient in this kind of situation ranks higher on the triage scale and generally speaking gets into a bed much quicker.
What’s interesting with the Melbourne story is that the hospital have responded by basically saying “We’re shocked that this has happened”
Staff are being interviewed, protocols are being reviewed, people are putting on grave faces and nodding to each other.
To be frank however, this is not the first time something like this has happened. Just google “miscarriage in waiting room” and you will be amazed at how common this is. And how outraged the public is each time. And how there are promises for investigations, enquiries, interviews.
The situation is unfortunate, yet it has also been highly sensationalised, playing on the fact that it’s a highly emotive situation.
What can we learn from it all? I agree the waiting room is probably not the best place for pregnant mothers with any form of PV bleeding. The really tricky thing is identifying which ones could do with a bed sooner rather than later, particularly when the department is pumping.
Let me ask you this: is there any good place to have a miscarriage?
I’d love to hear people’s thoughts on this subject, please comment below if you feel like it. And I’ll leave you with some of the comments by members of the public as found at the bottom of this original story. You probably won’t be surprised to find that once again there’s a wide perception by many members of the public that those nasty, incompetent, uneducated nurses are the ones truly responsible for this horrible situation, and are in fact the source of all problems in emergency departments.
Comments by the general public on the original story:
It’s not enough for the unit manager to apologize, each individual that was involved need to apologize personally and to accept personal responsibility. Saying you are just following procedure is the same as a soldier claiming they just followed orders. It’s no excuse. I had a similar experience of being referred by my doctor. He rang ahead and gave me a letter and it took 4 hours to get seen at a so called emergency department.
Australian state and central govt should hang its head in shame ( if there is any left, that is)…….
The triage system is a failure with nurses making decisions that they are not properly qualified to make. Doctors are the only ones who should be working triage. Send two doctors into the waiting rooms to assess patients as they arrive instead of making people wait hours on end. I’m sure you would see minor cases delt with on the spot and those that need an emergency bed be placed straight away. The biggest problem is that once the beds are full the doctors wander around aimlessly because they can’t see anymore patients until a bed becomes available. If you have someone taking up a bed because of a minor issue that could have been delt with in the waiting area by a triage doctor then the hospital is wasting resources that could have gone to someone in greater need of a bed and full medical attention. I feel for this family. Nobody should go through this. To experience the joy of giving life then having that life ripped away from you is horrific to say the least.
What professional neglect? Yeah its sad BUT she was given a triage category in the ED based on the potential severity of the condition and risk. Patients with life threatening conditions eg heart attacks and strokes are seen before potential miscarriage because you can do more to safe the lives of those patients rather than a miscarriage. If she got seen by a doctor sooner just to be told, “yeah your having a miscarriage. Dont flush the toilet so we can send it to pathology” then think about it – your mother might be dead because nobody gave oxygen and did an ECG to find out she was having a life threatening arrhythmia. Its all priorities in the ED. Such is life.
It’s a difficult situation and one that isn’t easy to address. As sad as it is, early miscarriages are usually an entirely natural process. I was fortunate when I presented to Emergency that they were able to find me somewhere private. It turned out my pregnancy was ectopic but I still had to wait 48 hours for ’emergency’ surgery. I understood there were more urgent cases – shootings, stabbings, twisted bowels, etc. You can’t send these women to maternity because the birth of a live child is more important and they wouldn’t want to be in that environment (new mums with new bubs) anyway. I do feel sorry for this woman but on the flip-side, how would you feel if your child was suffering a severe asthma attack or a head injury and not seen straight away because staff were busy dealing with an early miscarriage?
I can’t even describe how annoying it is to go to the emergency room and have a bitter nurse on the other side of the glass looking you up and down and deciding whether they think you’re unwell or injured enough to be put above someone else. I have got into full on arguements with some nurses… strangely enough I kept getting put further and further down the list to get seen (or those I am with) after these occasions… REAL FULLY QUALIFIED DOCTORS SHOULD BE QUESTIONING AND OVERSEEING THIS, not some nurses who hate their jobs and feel like buffering their weight around when panicked individuals come into the emergency department asking for help or to be seen.
This is tragic, no doubt. The Triage nurse is totally to blame, she is fully trained to be able to recognise this for the urgent situation that it is, she failed dismally. The GP had let them know she was on her way, and still they failed. No use putting politics into this. Do you blame the State Labor government or do you blame the Liberal Federal government that completely underfunded health for so many years?? They’ve all screwed it up.. Triage nurse is to blame here, plain and clear.