Clinical handover in context: risks and protections across a hospital patient's journey

Abstract

One weekday afternoon an 18-year-old patient, we'll call her Belinda Page, 1 arrives at the emergency department of a busy tertiary teaching hospital, complaining of shortness of breath and chest pain due to a flare-up of her asthma. During the six hours Belinda spends in the emergency department she develops additional symptoms - weakness and numbness, particularly down her left side. She undergoes an emergency MRI, x-rays and other tests but the emergency department night registrar, Dr Ken Lee - a relatively junior non-English speaking background doctor - cannot reach a diagnosis. Under pressure to move patients out of the emergency department as quickly as possible, during the night he calls the senior neurology consultant, Dr Richard Lancer, who declines to admit Belinda before reviewing her. Dr Lee then calls the Ward M consultant, Dr Allenanda, who reluctantly agrees to admit Belinda to a general medical assessment ward, until the neurology staff can review her the next day.