Rude awakening: Late-night discharge from Whanganui Hospital emergency department highlights pressures

Jonina Thomson with husband Graham, who was not expecting his wife to be discharged from Whanganui Hospital's emergency department in the middle of the night. Photo / Bevan Conley

A Whanganui woman has formally complained to Te Whatu Ora about how she was discharged from Whanganui Hospital in the middle of the night, which led her to begin walking home.

Te Whatu Ora says the woman was offered support to leave the hospital but she says she was too drowsy to accept it.

The situation has also highlighted the pressure hospital emergency departments can be under.

Jonina Thomson, 74, said the medication she was given made her drowsy and she was sound asleep when a doctor woke her up about 2am on July 16.

“He said the enzyme test they had conducted showed that I was well enough to go home and that the bed I was occupying was needed and that I should leave,” Thomson said.

“I asked him how I was expected to get home in the middle of the night and he said I could get a taxi. I told him that I had no money with me but he wasn’t interested.”

Thomson, who did not have a mobile phone with her, said she felt drowsy and disoriented and did not recall being offered any support to leave the hospital.

She removed the monitor attachments herself because a nurse was not present when she was woken.

“I removed the tubes that were attached to me and I walked out.”

Te Whatu Ora confirmed Thomson was discharged at approximately 2am on Sunday, July 16.

“We cannot discuss [the] treatment details of individual patients,” it said in a statement.

“Records show that on discharge the patient was offered support to return home in the form of a taxi chit and phone calls to support people, but refused the offers of support.”

Thomson said she did not believe that she was formally discharged. “I was disoriented and I was upset about the way I had been spoken to.”

The spokeswoman confirmed that a formal complaint matching the details given had been made and would be managed through the normal complaints process.

“An acknowledgment letter of the complaint is in the process of being sent to the person concerned,” she said.

Kath Fraser-Chapple, interim hospital and specialist services lead/kaihautu hauora for Te Whatu Ora Whanganui, apologised for Thomson’s experience and said the miscommunication should not have occurred.

It was always a preference to discharge well people as soon as possible to enable unwell patients better access to essential healthcare.

“Discharge is always done with care and compassion and people are aided to return home via taxi chits and phone calls to support people if necessary.”

Thomson said she left the hospital believing she would walk home to her house in Springvale.

A patient discharged from Whanganui Hospital in the early hours said she did not receive the expected level of support. Photo / Bevan Conley

“I have a friend who lives nearby so I walked up her steep driveway and banged on her door.”

Thomson’s friend Christine Smyth said that, although it was a shock to be woken at that hour, she was glad to be able to help.

“It was distressing to think that Jonina had been out on her own in the middle of the night and I was glad to be able to deliver her home safely.”

Graham Thomson said he was prepared to be woken by a call from the hospital but expected that his wife would be discharged much later in the morning.

Whanganui Age Concern manager Michelle Malcolm said her organisation liaised with Whanganui Hospital management to try to ensure the best care for older patients.

“We know that the ED services are stretched and staff are under incredible pressure but if an older person is being discharged at that hour of the night they need to take care to ensure there is adequate support to get them home safely.

“I’m sure if their mum or dad were in the hospital they would want them to receive the best care possible and that’s what they should be providing.”

Malcolm said Age Concern was aware that late-night discharges were often necessary due to the pressures on the service. However, it was imperative to ensure that older people were given the best care possible in the process.

“We have heard of a number of people being discharged at that hour and one man in his 70s had to pay for a taxi after he was told there were no chits available.

“If the person lives alone they are most likely going home to a cold, dark house. Even though they might have been diagnosed with a non-life-threatening condition they are most likely unwell and need support.”

Thomson said she was aware that hospital staff were under a lot of pressure but she found her discharge process unacceptable.

“I was half asleep and my recollection might be a bit hazy but I should have received better support.

“The staff at the hospital might be overworked and overwhelmed but they need to remember to show good care and respect.”

Fraser-Chapple said the hospital was at capacity when the situation occurred.

“There were 68 patients who attended ED on the night. Occupancy in the Emergency Department was at 147 per cent and occupancy in the acute wards of the hospital was 100 per cent.

“Whanganui Hospital is not immune to patient flow issues and it may not be evident to the public just how busy the hospital is behind the doors of ED.

“The hospital regularly operates at a high level of occupancy. Occupancy can fluctuate from day to day – and even hour to hour – as patients are admitted and discharged.

“ED is just one element of the patient flow process. If there is a high occupancy of beds within the hospital there is not always the option of admitting people overnight.

“The discharge of well people, who have not previously been admitted to a ward, can occur during the night. Staff offer all assistance for people to return home safely.”

Thomson presented to ED because she believed she was experiencing a heart attack on the night of July 15. Husband Graham drove her to hospital about 7pm.

“I have a history of cardiac problems and we’re always encouraged to go straight to an emergency department if we experience chest pains and breathing difficulties. It was tachycardia [irregular heartbeat] which I had experienced before and it can feel like a heart attack,” she said.