STROKE MEDICAL NEGLIGENCE DELAY IN TRANSFERRING PATIENT TO STROKE CENTRE

John Whelan Solicitor with specialist expertise in Stroke Medical Negligence gives an example of delay in transferring a Patient to Stroke Centre.

An example of a case of Delay in Transferring the Patient to a Stroke Centre

Case Example: Delay in Transferring a Patient to a Stroke Centre

A Patient, experiences sudden onset of slurred speech, weakness on the left side of his body, and difficulty walking while at home. His wife recognises the signs of a stroke and calls emergency services immediately.

Initial Response:

a) An ambulance arrived within 15 minutes and they assess the Patient. They suspect an ischemic stroke based on his symptoms and the rapid onset.

b) Unfortunately, the nearest hospital, a community hospital, is a small facility without specialised stroke services, such as mechanical thrombectomy (an advanced treatment used to remove large blood clots) or a stroke neurologist on site. The paramedics contact the community hospital and are advised to transport the Patient there for initial stabilisation.

Arrival at the Community Hospital:

a) The Patient arrives at the community hospital about 45 minutes after symptom onset. He is evaluated by the A&E physician, who confirms the signs of a stroke. A CT scan is performed, which shows no bleeding in the brain, suggesting an ischemic stroke. However, the hospital lacks the capacity to perform advanced imaging, like a CT angiogram, which would better assess whether the Patient has a large vessel occlusion (LVO) that would require mechanical thrombectomy.

b) The hospital is also not equipped to administer tPA (tissue plasminogen activator) on-site and does not have a neurologist available to guide care.

Delay in Decision Making:

a) There is no established protocol at the community hospital for rapid transfer to a stroke centre, so the A&E staff attempt to stabilise the Patient while considering options.

b) A telephone consult with a neurologist from a nearby stroke centre is delayed due to technical issues. After finally connecting, the neurologist recommends immediate transfer to a comprehensive stroke centre for potential mechanical thrombectomy and thrombolytic therapy.

c) Unfortunately, this recommendation comes over 2 hours after the Patient arrival at the community hospital, leading to a significant delay in his treatment.

Transfer to a Stroke Centre:

1. The Patient is transferred by ambulance to a comprehensive stroke centre, which is approximately 30 minutes away.
2. By the time the Patient arrives at the stroke centre, more than four hours have passed since the onset of his symptoms, meaning he is now ineligible for tPA.  He undergoes further imaging, which confirms a large vessel occlusion that would have been amenable to mechanical thrombectomy.
3. A mechanical thrombectomy is performed to remove the clot, but the delay has reduced the chances of a full recovery.

Outcome:

The Patient survives the stroke but is left with significant right sided weakness (hemiparesis) and speech difficulties (aphasia). With timely intervention, especially within the first 4.5 hours, his outcome might have been significantly better.

Important Points of the Case:

1. Delay in Transfer.
2. Lack of Protocol for Rapid Transfer.
3. Missed Treatment Window.

For more detailed insights into how Stroke Medical Negligence and Patient Safety impacts you and how Whelan Law can support you, please visit our Patient Safety Rights Legal Advice https://www.whelanlaw.ie/news/stroke-medical-negligence-claims-what-you-need-to-know/