"Delay in rehydration"

Last week, my child was admitted to Armadale Hospital with pneumonia. We had an excellent experience with the staff in the paediatric department, and the paediatricians were outstanding—particularly Dr. Abbas. He went above and beyond to care for our family. Not only did he suggest taking my child's twin sister to the GP due to her fever, but he also personally contacted the GP to discuss the treatment protocol. Furthermore, Dr. Abbas issued a script to the hospital pharmacy for Azithromycin when we were unable to find it elsewhere due to a shortage. These actions, while not required, reflect his remarkable dedication to his profession and his patients.

Unfortunately, I cannot extend the same praise to the Emergency Department (ED) team at Armadale. I brought my child to the ED late at night due to her persistent fever, vomiting, lethargy, and dehydration. Her fever had been worsening for days, with temperatures spiking above 39.5°C despite regular doses of Panadol and Nurofen. She continued to vomit even after taking Ondansetron and had produced only two small urine outputs in over 30 hours, which made her dehydration very concerning.

After waiting for 1.5 hours in the ED waiting room (during which a nurse kindly offered Hydrolyte), my child was taken into the ED. The nurse in ED offered Panadol, Nurofen and Ondansetron. My child was finally seen by the RMO about 30-45 minutes after being taken to ED and then by the Registrar. The Registrar explained that my child needed an IV cannula and offered to apply a local anaesthetic to minimize pain. However, this would require waiting an additional 30 minutes before proceeding. Given my child's dehydration, I requested that the cannulation be done immediately to avoid further delay in administering IV fluids. The registrar inserted the cannula promptly and informed me that my child was being referred to the paediatrician.

After this point, however, I did not see any further involvement from the ED doctors. Despite the cannula being inserted, no IV fluids were started for several hours. I approached a nurse to inquire about the delay and was told that they were waiting for the paediatrician to assess my child. Unfortunately, the paediatrician was busy and only saw my child 2–2.5 hours after the cannulation. IV fluids were finally started 2.5–3 hours after the cannula was placed.

This experience left me deeply disappointed. It appeared that the ED doctors relinquished their duty of care as soon as the referral to the paediatrician was made. For a child with dehydration, prompt rehydration is critical and should not require waiting for a paediatrician's assessment in an otherwise healthy child. Every hospital should have fluid resuscitation and maintenance protocols in place, and even an RMO should be able to initiate IV fluids in such cases.

I strongly believe that the work culture in the Armadale ED needs significant improvement to ensure better outcomes for the patients they serve. Prompt and proactive care, especially for children in critical need, should always be a priority.