Table 5 Examples of different perspectives on preventability

Patient VS doctor at ED and GP

A patient, familiar with prostate carcinoma and brain metastases, was recently admitted to the hospital because of neurologic decline due to brain haemorrhage. After discharge, he wakes up in the middle of the night and hears voices. He knows the voices are not real (pseudo hallucinations). He directly presents at the ED. At arrival at the ED the complaint is not there anymore and the doctors relate the complaint to medication side-effects. The doctor at the ED and the GP argued that the patient could have contacted the GP first instead of bypassing him. After assessment of the patient the GP could contact the specialist and they could make a care plan together. When they agree that there would be no alarm symptoms they could decide to not send the patient to the ED. An URP could potentially be prevented. The patient argued that he was scared and connected the complaint with an underlying cause of the brain. Since he was well known in the hospital, it seemed logically for him to present at the ED.

GP VS patient and doctor at ED

A patient presented at the ED after a fall. There were no fractures and the patient was diagnosed with contusions and discharged home. The patient is in pain therefore he receives painkillers and he is limited in mobility. Since the patient received no homecare and lives without partner and has no family to look after him, the advice of the doctor at the ED towards the GP was to arrange supportive care. After 5 days the patients returns to the ED with a fall again. In the 5 days in between there was no additional care arranged. The patient and doctor at the ED argued that the URP was potentially preventable. The GP argued that he frequently recommended home care to the patient over the past year, but the patient refuses to accept additional care. The patient is on a waiting list for a supportive care facility and in the meanwhile he does not allow anyone else entering his home.

Doctor at ED vs patient and GP

A patient presents at the ED with pain in the pelvic region without trauma. He got discharged home with pain medication. Two days later he returns with progression of pain and muscle weakness in the legs and urine incontinency and got admitted with working diagnosis of cauda equine syndrome. The patient and the GP argued that the patient had to be admitted the first time since the pain was not controlled with the medication. The doctor at the ED argued that there was no indication for admission the first time since there were no alarm symptoms back then.