ER Scenario 1: Failure to Communicate

[Sender Name and Address]

Date: [Date Letter is Written]

To: [Recipient Physician and Dept Name]
[Address]

RE: Emergency Department Visit for [Patient Name] on [Date of Visit]

Dear [Recipient Physician Name],

I am writing to formally express my grave concern regarding the care and discharge of my [Relationship, e.g., son], [Patient Name], following [his/her/their] admission to the [Department Name] on [Date of Visit].

[Patient Name] arrived at the hospital at approximately [Arrival Time] accompanied by [his/her/their] family. Upon arrival, [he/she/they] provided explicit consent for us to be involved in [his/her/their] care and for information to be shared with us. [Patient Name] was [Brief description of patient's state, e.g., very agitated] and had been experiencing [Specific clinical symptoms/behaviors, e.g., what we think were psychotic episodes] earlier that day. Throughout the duration of [his/her/their] stay, we remained in the waiting area and repeatedly requested to speak with either the attending physician or the assigned nurse to provide critical context regarding [his/her/their] history and recent observations.

Despite being present for over [Length of stay, e.g., ten hours], we were never consulted. At approximately [Discharge Time], my [Relationship, e.g., son] was discharged and sent back to our home in a [Mode of transportation, e.g., cab]. This discharge occurred without any communication with us, without a formal diagnosis, and without a treatment or safety plan in place.

Had a member of the clinical team spoken with us, we would have shared vital information that was necessary for a safe assessment. Specifically, that [Patient Name] had:

• [Specific Clinical/Personal Detail 1, e.g., The patient had recently discontinued his prescribed medications.]
• [Specific Clinical/Personal Detail 2, e.g., He had been making statements regarding self-harm in the days leading up to the ER visit.]

The decision to discharge [him/her/them] without a diagnosis or treatment plan, and without a safety plan has placed [him/her/them] at significant risk. Since returning home, [his/her/their] illness has escalated, and we are now in a position where [he/she/they] urgently requires the diagnosis and treatment that should have been initiated during [his/her/their] [Length of stay] stay at the [Hospital Name] [Department Name].

We are requesting a written explanation regarding the following:

• Why was [Patient Name]’s consent to involve [his/her/their] family disregarded?
• Why was a patient with known risks discharged without a consultation with the caregivers who would be responsible for [his/her/their] immediate safety?
• Why was no treatment plan or safety protocol established prior to [his/her/their] release?

We look forward to your prompt response and a clear explanation of how this breakdown in communication occurred and how it will be prevented in the future.

Sincerely,

[Sender Name]

[Your Name and Address]

[Date]

[Recipient Name, Title, Dept]
[Hospital Name and Address]

RE: Quality of Care and Discharge Safety for [Patient Name] on [Date of Service]

Dear [Recipient Name]:

I am writing to you in your capacity as [Recipient Title] at [Hospital Name] to request that you explain why my [Relationship, e.g., son], [Patient Name], was discharged from your Emergency Department on [Date of Service], by [Attending Physician Name], without any discussion with me about [his/her/their] recent symptoms and without any discussion about how [his/her/their] condition could be safely managed in my home. I sent a formal letter to [Attending Physician Name] on [Date First Letter Sent], but received no reply.

My [Relationship] told me that [he/she/they] had asked that I be part of any discussions about [his/her/their] treatment. Despite [his/her/their] explicit consent that I be involved, and despite the fact that I stayed in the waiting area for over [Number of Hours] hours, I was not consulted. In fact, my [Relationship] was discharged via [Mode of Transportation, e.g., taxi] late that night without a treatment plan, or any communication with my family who are responsible for [his/her/their] safety.

This appears negligent to me given that:

• The clinical team failed to gather critical collateral information regarding my [Relationship]’s recent [Specific Clinical Detail 1, e.g., medication non-compliance] and statements that [he/she/they] intended to [Specific Clinical Detail 2, e.g., harm himself].
• My [Relationship] was discharged while in an unstable state which, in my opinion, led to a subsequent escalation of [his/her/their] illness at home.

As the individual responsible for the clinical care in the emergency department at [Hospital Name], I am requesting that you review this case to determine why:

• [Attending Physician Name] and the clinical team did not collect collateral history.
• A patient at high risk for [Specific Risk, e.g., suicide] was discharged without any attempt to develop a safety plan with family caregivers.

And, if you conclude that the expected standard of care has not been met:

• What steps is the hospital taking to ensure that physician-caregiver communication is prioritized in accordance with provincial legislation and professional standards.

I look forward to a written response detailing the findings of your review. Can I ask that you reply before [Deadline Date] so that I can be assured that you are giving this matter the attention it requires and do not need to take it to another level.

Sincerely,

[Your Name]

[Your Name and Address]

[Date]

[Recipient Name, Title, Dept]
[Hospital/Institution Name and Address]

RE: Formal Complaint – Systemic Failure of Patient Safety and Caregiver Engagement

Dear [Recipient Name],

I am writing to you in your capacity as [Recipient Title] for the [Hospital/Institution Name] as you are responsible for ensuring that the hospital’s policies and clinical practice provide safe and appropriate care for the hospital’s patients and the community as a whole. In my opinion, the hospital failed to provide safe and appropriate care for my [Relationship, e.g., son], [Patient Name], on [Date of Incident]. As I have been unable to obtain a satisfactory answer for the cause of this failure from either the [First Contact/Staff Title, e.g., attending psychiatrist] or from the [Second Contact/Staff Title, e.g., Chief of Emergency services], I am bringing it to your attention.

A brief summary of the facts are that on [Date of Incident], my [Relationship] was admitted to the [Department Name, e.g., Emergency Department] due to [Reason for Admission/Medical Issue]. Neither [Doctor/Clinician Name] nor any other clinician talked to me about [Patient Name]'s symptoms or behaviour at home. This failure occurred despite the fact that I [Details of your presence, e.g., stayed in the emergency department for over ten hours] and the fact that my [Relationship] had given permission for the clinicians to speak with me. As a result, [Doctor/Clinician Name] was apparently unaware that [Patient Name] had [Critical Medical Context, e.g., stopped taking his prescribed medication for the previous two months]. Nor was [Doctor/Clinician Name] apparently aware that [Patient Name] had [Critical Risk/Safety Detail, e.g., repeatedly threatened to harm himself].

Lacking this critical information, [Doctor/Clinician Name] discharged [Patient Name] [Discharge Circumstances, e.g., back to the community with a taxi voucher] but without any notification to our family or without any post-discharge plan.

In my opinion, this incident is more than an individual clinical error. Rather, it reflects a systemic failure to:

• Follow the patient's appropriate wishes: The request to include [his/her/their] family caregivers was ignored.
• Obtain important information from caregivers: The clinical team was unaware of vital information that would have altered the assessment and discharge decision.
• Prioritize patient safety: Discharging an unstable patient at high risk of [Specific Risk, e.g., self-harm] without a safety protocol is a breach of the fundamental duty of care.

In my opinion, the inappropriate discharge of my [Relationship] resulted in [Outcome/Consequence at home].

As [Recipient Title], you are responsible for the culture of safety and policy adherence within your institution. I am requesting that you investigate the systemic gaps that allowed this failure to occur and provide me with a summary of the corrective actions being implemented to protect other families from similar experiences.

I hope to receive your response before [Response Deadline Date] to avoid having to pursue this matter through alternative channels.

Sincerely,

[Your Name]