Tashonna Ward

Hoosier_RN, MSN · Jan 17, 2020

This is sad all around. But when she left on her own accord, I think that the hospital may be off the hook.

Short of breath and chest pain, she should have been on a monitor...I wonder how this will play out

KatieMI, BSN, MSN, RN · Jan 17, 2020

She was in ER a few minutes less than 2 h 30 min. She was automatically stratified as low risk for ACS (25 years old female). She was triaged as "low risk" and appropriate workup was started so that the provider would have something to work with. Apparently, there was nothing to signify a dire emergency like crushing pain, hypoxia requiring continuous oxygen or BP of 260 systolic.

2 h 30 min is quite normal waiting time for busy urban ER. It can be MUCH longer between 5 and 7 PM at any given day.

Cardiomegaly found during or right after pregnancy could point on something serious like postpartum cardiomyopathy (with her risk factor of being African American), myocarditis, or other nonischemic cardiomyopathy but she should be consulted and provided with outpatient workup arrangements right after cardiomegaly was found first. We do not know if it was done and if she followed up as recommended, or even if she had a PCP.

It is definitely no good that nobody took a moment to sit with her and explain what was going on and why she got to wait like everybody else and the whole ER not dancing around her doesn't mean that nobody cares about anything. But it was busy urban ER with possibly many people making their chief complain of magic words "chest pain and shortness of breath". She left AMA and on her own accord, thus personally accepting any responsibilities for the sequela. The hospital likely will be off the hook providing all paperwork was filled accordingly.

BTW, the fact that "she even did not have a bracelet" already doesn't fit into the story. Unless the ER operates by standards of last century, she couldn't get an Xray or ECG without it.

Guest219794 · Jan 18, 2020

I read a bunch of the news stories.

Not one mentioned a few critical facts-

"Chest pain and shortness of breath" have become synonymous with "I don't really want to wait". Obviously they can be signs of something serious, but there is no way for a busy ER to straight back every person who chooses those words.

Increasing pressure for customer satisfaction has resulted in prompt treatment of non-emergent issues. In a system with limited capacity, whatever resources go into toe pain get pulled from chest pain.

An ER doc will not be faulted for doing an 8 hour work up in search of that unicorn that PCP and multiple specialists have missed. The doc will actually be held more responsible for missing that than for clogging up the ER while an actual sick person can't get in.

And, while they did mention these facts, there was no emphasis that this patient was getting worked up for her complaint when she chose to leave.

Hoosier_RN, MSN · Jan 18, 2020

I agree @hherrn. Not only did it not mention details about the wait, we don't how busy that ER was and acuity of others present. So many details missing. And many yell chest pain/SOA to get seen quicker; it happens in every setting, every day. At the end of the day, she left to go elsewhere.

When I went to nursing school, we learned to triage by emergent need. Now, it seems, all things are treated equal. How dare we not give a stubbed toe the same treatment as a GSW victim? Because of that mindset, we now have situations like this

Sour Lemon · Jan 18, 2020

I'm inclined to think B is closer to the truth. We don't know who else was being treated in that ER at that time. And despite this patient's difficulties, she was "okay" enough to walk out and drive off.

Hoosier_RN, MSN · Jan 18, 2020

Another thought: was the deceased a frequent flyer? One who possibly came in with the same complaint often? Not that it makes her death any less acceptable, but if she were a FF who did that, I could see triage parking her while seeing someone who came in with something that seemed to warrant priority treatment. Just a random thought...

Workitinurfava, BSN, RN · Jan 18, 2020

Well studies have been done that black women are not given the same urgency in treatment or care as white women.

**LibraSunCNM, BSN, MSN, CNM** · Jan 18, 2020

Yikes, what a sad story. From the very bare basics we get in this article, it sounds to me like she didn't get proper postpartum follow up and care (a very common problem in the U.S., which is exponentially worse for women of color), which spiraled into the situation that led to her death, even if that situation wasn't actually the ED's fault.

Emergent, RN · Jan 18, 2020

The article I read was your typical sensationalism that the media loves, that is entirely one-sided. They don't even list the actual cause of death. Probably autopsy results are pending.

We get short of breath, chest pain young people frequently. An EKG is always done immediately, and 99.9% of the time it's anxiety, chest wall pain. or something else benign.

In this case, the patient qas in an extremely busy ER and got impatient, and probably angry, and left. People of all races and creeds do this sometimes. In this case it was a bad decision.