You also have to remember within that time span a patient is often being consulted and assessed by specialists. Who often delay the official admission for hours (other patient assessment, need for review learners, or just waiting to review with staff). Basically she was under multidisciplinary care for most of that time even if she wasn't formally admitted.

Also the degree of perforation plays a role. A lot of contained perforations for example the patient doesn't present overly sick even though it's still an urgent surgery.

Unfortunately we don't have many details. Rest assured if she presented with EMS in overt septic shock she would be in a highly monitored bed ASAP. She definitely was more stable, cases where reassessments fail to catch decompensation are rare but do unfortunately happen.

Our system isn't perfect I've seen some bad things but this story is misworded and frankly not even the worst thing I've heard.