Global Health Systems 1st Edition by Margie Lovett Scott ,Faith Prather

Exercise 4

Anna, an 82-year-old female, fell on her kitchen floor injuring her right side and chest. Accompanied by her daughter, she was taken by ambulance to the hospital nearest her home, as is expected under the National Health Plan in the United Kingdom. Because there were no beds in the emergency department, Mrs. Anna remained on a gurney for six hours while being evaluated. As she waited for a bed, she tied up the ambulance gurney as well as the EMS workers as they could not leave for another call until the gurney was free and the hospital does not have loaners.
Mrs. Anna was most uncomfortable during her stay in the emergency department. She complained of intense pain in her chest and ribs for which she was given narcotic pain medication. She had x-rays and blood work and was told, after six hours, she was fine and could go home. In less than three hours, the daughter received a call from the hospital insisting that she return her mother to the hospital because her potassium level was dangerously high; to which the daughter responded, "That is not surprising since she is on dialysis. Her next treatment is tomorrow and I am sure her potassium level will decrease after her treatment." However, the doctor convinced the daughter to return to the hospital with her mother who continually complained of pain, for which she continued to receive narcotic pain medicine. The next day, because there were no dialysis services at that hospital, and the Health Plan did not provide for transportation, her daughter transported her mother to her dialysis treatment outside the hospital. Because Mrs. Anna was so short of breath and continually complained of pain, her three hour dialysis treatment was stopped after 1½ hours.
They returned to the hospital where Mrs. Anna remained for 4 days. Mrs. Anna did not appear to be improving and was now complaining of severe abdominal pain; her abdomen appeared impregnated and hard. The daughter, now joined by the granddaughter, kept advocating on Mrs. Anna's behalf that more be done to determine the problem. The family overheard one of the doctors say, "she has no bowel sounds." The granddaughter, a prominent nurse, intervened, insisting that her grandmother be checked for a bowel obstruction. She was told that was not an option; families do not make such decisions and because of Mrs. Anna's age, the physicians would not support such an aggressive treatment plan. The family was outraged; their mother and grandmother was a very happy, active, and productive family member who could not simply be dismissed. They continued appealing to the doctors and nurses to do the right thing. A few hours later the daughter overhead a nurse speaking with a physician about the situation saying, "I don't know what we are going to do with this family, and one of them is an American!" The family removed Mrs. Anna from that hospital, and she was admitted to a private hospital where the daughter paid out-of-pocket for her care. Five days after her fall she was diagnosed with five broken ribs, and a perforated bowel that the family suspected was narcotic-induced.
If Mrs. Anna is tying up the only available gurney for six hours, how many other people may be at risk for emergency service? Would this situation happen in your work setting? How many calls for emergency service occur per hour in your area? Would you say your health setting is well-equipped and responds effectively to emergency situations? What does Mrs. Anna's situation suggest about access to emergency care under the National Health Plan?