Ireland: Waiting Times In A&E: What Are You Telling Your Patients?

Last Updated: 5 November 2018
Article by Joanelle O’Cleirigh and Sinead Reilly
Most Read Contributor in Ireland, October 2018

Hospitals may be liable where their receptionists give patients misleading information as to the availability of medical assistance.

A recent decision of the UK Supreme Court found an NHS Trust liable after a hospital receptionist gave a man with severe head injuries incorrect information as to waiting times, resulting in the man leaving the hospital without being examined by a doctor or nurse. Unfortunately the man later suffered permanent brain damage.

While not binding on the Irish courts, the decision may be of persuasive authority and those operating hospitals in Ireland can certainly learn from the decision.

MISLEADING INFORMATION

In 2010, a man attended at a London A&E department having been attacked and struck on the head. He told the receptionist he felt as if he was about to collapse and that he needed urgent medical attention. The receptionist told him that he would have to wait four or five hours before he was seen.

This information was incorrect. The system in place at the hospital was that anyone presenting with a head injury would be seen by a triage nurse within 30 minutes of arrival or as soon as possible and the nurse would determine how urgently the patient needed to be seen by a doctor. This system operated effectively and the receptionists on duty at the time were aware of this.

The man left the hospital after 19 minutes without informing any staff. He collapsed within an hour of leaving and was rushed back to hospital by ambulance. Unfortunately he suffered permanent brain damage.

The man sued the NHS Trust, and ultimately won on appeal to the UK Supreme Court.

CRITICAL FINDINGS

The trial judge made a number of critical findings:

  • Had the man been told that he would be seen within 30 minutes, he would not have left the waiting area and his later collapse would have occurred in the hospital. In such circumstances, he would have been treated sooner and would have made a near full recovery.
  • The man's decision to leave was made, at least in part, on the basis of the incorrect information provided to him by the receptionist.
  • It was reasonably foreseeable that a person who believed that it may be four or five hours before he would be seen by a doctor may decide to leave the hospital.

RECEPTION STAFF

The UK Supreme Court found that the receptionist in this case negligently imparted incorrect information, leading to a breach of duty on the part of the NHS Trust.

The Court noted that those responsible for running A&E departments have a duty to take reasonable care not to cause physical injury to patients. This includes a duty to take reasonable care not to provide misleading information which might foreseeably cause physical injury.

The Court drew no distinction, in the circumstances of the case, between medical and administrative staff. The NHS Trust had given the responsibility to provide information on waiting times to receptionists. While receptionists clearly cannot be expected to give medical advice, they should take reasonable care not to provide misleading information as to the likely availability of medical assistance.

WHAT DOES THIS MEAN?

The duty is one to provide reasonable care when providing information as to the period of time within which medical attention is likely to be available. It is not a duty to provide minute-perfect or hourperfect information about how long the waiting time might be or to update patients as waiting times change.

Reception staff should bear in mind that people attending A&E may use the information they are given about waiting times to decide whether to wait to be seen or to leave. They should have a reasonable basis for any time estimate they provide and should be careful not to over-estimate waiting times in an effort to manage patients' expectations. If, for example, reception staff tell patients that the waiting time is 5 hours when they know it is closer to 1 hour and that urgent cases may be dealt with quicker, this could potentially expose the hospital to a liability.

REDUCE THE RISK

  • Review your policies in relation to reception staff and ensure you have clear guidelines in place as to what information should be provided to patients when they first present themselves. If you do not have a policy, create one.
  • Place notices that accurately explain the procedure for admitting patients prominently in hospital waiting areas.
  • Provide training to all reception staff on managing admissions and dealing with patients.
  • Ensure that all reception staff understand the potential consequence of misleading information, not only in monetary terms, but also in terms of a person's health and well-being.

This article contains a general summary of developments and is not a complete or definitive statement of the law. Specific legal advice should be obtained where appropriate.

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