一名患有严重精神疾病的妇女由于护理协调失败而死亡,这促使人们呼吁进行系统改革。 A woman with severe mental illness died due to care coordination failures, prompting calls for systemic reform.

对Tiesha Derbyshire的死亡进行调查后发现,在Ipswich医院的护理协调和相关服务方面存在差距。 Tiesha Derbyshire患有严重精神疾病。 An inquest into the death of Tiesha Derbyshire, a woman with severe mental health conditions, has exposed gaps in care coordination at Ipswich Hospital and related services. 尽管她有自残和多次住院的历史,但精神科医生和全科医生之间的沟通失灵使她的GP不知道她的全部风险水平。 Despite her history of self-harm and multiple hospitalizations, communication failures between her psychiatrists and general practitioner left her GP unaware of her full risk level. 调查指出,没有机会获得更好的护理,包括没有充分利用联邦医疗保健计划资助的病例会议方案,并着重指出了心理压力因素,包括失去一个亲密朋友和据称与一名护士关系不当,护士后来受到斥责。 The inquest cited missed opportunities for better care, including underuse of a federal Medicare-funded case conferencing program, and highlighted psychosocial stressors, including the loss of a close friend and an alleged inappropriate relationship with a nurse who was later reprimanded. 家庭成员说,系统失灵和创伤是造成她死亡的原因。 Family members said systemic failures and trauma contributed to her death. 验尸官建议改进患者搜索规程,加强实施护理协调措施,以防止今后发生悲剧。 The coroner recommended improved patient search protocols and stronger implementation of care coordination measures to prevent future tragedies.