Who Is Responsible?
Who is responsible for the patient when they
go to another department for testing? You ask
why I ask this?
A few months ago I was a patient in the hospital
and the tubing to my chest tube came apart. After
the MD corrected the problem, the chest tube
hooked up to suction and an x-ray was ordered. Because I was on suction it was determined I would go down to x-ray on my bed versus in a wheelchair so a portable suction machine could be transported easier.
My assigned RN came in with a portable suction machine, turned it on and after he found it was working, he connected the chest tube to the portable suction machine and left the room. I waited patiently for transport personnel. The transporter staff member came in a few minutes later. As I was pushed on the elevator I noted I did not hear the suction machine anymore. The transporter said they thought it was fine.
Arriving in the x-ray department they were backed up. My bed with me in it was parked in the hallway to wait my turn. After about 10 minutes I stopped someone as they walked by and asked if the suction machine wasn’t supposed to have a sound coming from it when it was on. They stated they would check with the desk. The clerk at the x-ray check in desk came to look at it. She said she did not know either but would try to find someone to look at it. I could hear her calling different departments around x-ray to try to get a nurse to come look at it. Finally after about another 5-8 minutes a nurse came over from somewhere. She stated, “ I don’t hear anything but I don’t know much about these” She tried plugging it into the wall and still nothing and she left.”
After another 5-6 minutes I called to the clerk to ask if someone else would be coming to look at the suction machine. I reminded her it was the MD that ordered to have the tube hooked up to suction. She stated she didn’t know whom else to call, that no one wanted to come over. I asked her if she had checked with my floor nurse and she said she had not thought to do that. She called, and he came down. He checked the settings, plugged it in and unplugged it and plugged it in again. It came back on so he left to go back to his floor. He had barely left the floor when the machine turned off again. Before I could notify the clerk, the x-ray tech came out and pushed me into x-ray.
After the x-ray, they called the transporter and explained they needed someone to come right away because my suction machine was not working. I was quickly transported back to my room. After about 10 minutes I notified my nurse I was back in the room and that my suction machine was not working. The RN came in and I was placed back on wall suction.
I tell you this story not to complain about my care but to show a flaw in the hospitals system. Luckily this was day 7 of my hospital stay and I was pretty stable, but had this happened to a patient with less reserves the outcome could have been very different. I am an Registered Nurse so I knew the machine was not functioning properly. What if this had occurred to a non-nurse would they have known to ask to have someone look at the equipment?
Had the outcome been different who would have been liable for the equipment failure, and the lack of monitoring? I did inform the hospital of the incident when I filled out my satisfaction survey after discharge. I did so because it was obvious this hospital did not have a protocol to guide the x-ray staff of how to respond for incidences such as this, or if they did, the staff most definitely needed more education. Facilities should also have a good protocol on monitoring patients during transport, and on storing and checking portable equipment regularly.
There are many reasons a patients condition my deteriorate when in they are in another department. Staff need to know how to Identify issues and respond in a rapid appropriate manner.
It is often these types of issues that harm patients, and land the medical profession in court. A nurse consultant as part of a risk management team can help medical facilities identify flaws and prevent lawyers from wining cases.
Just how common do these “near misses or incidents” occur during or with intra-hospital transfers? Recommended reading to learn more
Ott, L. K., Hoffman, L. A., & Hravnak, M. (2011). Intrahospital Transport to the
RadiologyDepartment: Risk for Adverse Events, Nursing Surveillance, Utilization of a
MET and Practice Implications. Journal of radiology nursing, 30(2), 49–52.