The Garling Report (formally titled the ''Final Report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals'') is a 2008
report
A report is a document that presents information in an organized format for a specific audience and purpose. Although summaries of reports may be delivered orally, complete reports are almost always in the form of written documents. Usage
In ...
prepared by the office of the Australian Commissioner
Peter Garling
Peter Garling, RFD (born in 1952 in Kuala Lumpur, British Malaya) is an Australian judge, a Judge of the Supreme Court of New South Wales, the highest court in the state of New South Wales.
Garling is noted for his involvement in multiple hi ...
, SC following a series of high-profile medical mishaps in the
New South Wales
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, nickname =
, image_map = New South Wales in Australia.svg
, map_caption = Location of New South Wales in AustraliaCoordinates:
, subdivision_type = Country
, subdivision_name = Australia
, established_title = Before federation
, es ...
public hospital system. For the duration of the commission, it was well covered by mass media. Its final 139 recommendations stimulated considerable discussion and controversy.
Background
In November 2005, an Australian teenager named Vanessa Anderson died at
Royal North Shore Hospital following a golfing accident. Her death, widely reported in the media, led to long-running controversy and motivated government-level changes to public hospital policy. It was alleged that her death occurred due to inadequate
care
Care may refer to:
Organizations and projects
* CARE (New Zealand), Citizens Association for Racial Equality, a former New Zealand organisation
* CARE (relief agency), "Cooperative for Assistance and Relief Everywhere", an international aid and ...
and a systemic hospital failure to recognize signs of a deteriorating patient.
On 6 November 2005, while attending a school sporting event at a golf course, Vanessa Anderson was hit on the head by a golf ball. She was taken to
Hornsby Hospital
Hornsby Ku-ring-gai Hospital is a hospital in Sydney, Australia, located on Palmerston Road in Hornsby. As a provider of care since 1933, the Hornsby Ku-ring-gai Hospital is a major metropolitan hospital, and is a teaching hospital of the Univer ...
and subsequently transferred to the
Royal North Shore Hospital. She was allegedly treated inappropriately for a fractured skull, and two days later, suffered a seizure and died. The coroner determined that Vanessa died from respiratory arrest due to the depressant effect of opiate medication.
The incident, among others, led to a 2008
commission,
NSW Health Media Release 25 January 2008 ''Peter Garling SC to lead Special Commission of Inquiry''
/ref> authored by Peter Garling, to investigate the standard of patient care in public hospitals, which found a "prevalent" problem associated with the care of the deteriorating patient.
In 2010, the NSW Health Department conceded that Vanessa's death was unnecessary, tragic and avoidable, and that a new system of monitoring vital signs to detect deteriorating patients was needed statewide. This system includes red and yellow "Between the Flags
Between is a preposition. It may also refer to:
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" color-coded observation charts for recording a person's vital signs, allowing for easy visual recognition of deterioration. Observation charts have been developed for Adult, Pediatric, Maternity and Emergency patients.
By 2012, every state hospital in New South Wales adopted the Between the Flags system, implementing Between the Flags Standard Observations Charts and a Clinical Emergency Response System (CERS) that details the process for calling for help and the clinicians required to attend. Medical officers, nurses, allied health practitioners (including physiotherapists) and other staff now undergo mandatory training to adhere to these standards. This manner of recording and acting upon variations in haemodynamics is now also taught to medical and nursing students in NSW.
See also
*Acute care
Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery.Alberta Health ServicesAcute care.Acces ...
References
External links
SMH Beach jargon can be lifesaver in hospitals, too
{{DEFAULTSORT:Garling Report, The
2008 in Australia
2008 works
Hospitals in New South Wales