Inadequate Differential Hinders Chance to Prevent Paralysis
This case study was made available to MIEC through our partnership with CRICO. It was written by Annette Roberts, MSN, RN, CRICO Description A young adult with a history of IV drug use became paraplegic after repeated Emergency Department (ED) visits for a complaint of back pain. Key Lessons When a patient is unable to communicate or give a history, seek collateral information from family members if possible. Unconscious biases can cloud judgment, leading to skewed differential diagnoses and the potential for a delay in treatment. Contemporary communication and documentation of a patient’s status change is critical for acute...
Unit Ill-prepared for Labor and Delivery Complications
This case study was made available to MIEC through our partnership with CRICO. It was written by Jennifer Vuu Sanchez, CRICO Description A fetal death was attributed to a failure by the obstetrics team to identify and respond to uterine rupture. Key Lessons Early signs of fetal distress should trigger the decision process re: early intervention Review of, and adherence to, policy/protocol is essential to patient safety The scope of practice requirements for covering physicians should be clear to all providers on the Labor & Delivery Unit Clinical Sequence 1:00 p.m. A 30-year-old gravida 2, para 1 patient with a...
Gaps in Clinical Workup Lead to Young Patient’s Missed Colorectal Cancer
This case study was made available to MIEC through our partnership with CRICO. It was written by Melissa DeMayo, CRICO Description A 33-year-old woman was diagnosed with colon cancer more than two years after her initial complaint of rectal bleeding. Key Lessons Gaps in clinical workup can lead to flaws in medical decision-making. Sub-optimal surgical/invasive procedures can lead to missed diagnoses. Clinical Sequence A 31 -year-old woman with no significant medical history complained of rectal bleeding to her primary care physician, a cardiologist. At this visit, she also described hard stools with hematochezia and possibly hemorrhoids. The cardiologist performed a...
This case study was made available to MIEC through our partnership with CRICO. It was written by Melissa DeMayo, CRICO Description Six days after his initial visit to Urgent Care for ear pain and facial paralysis—and after three CT scans—a 28-year-old man was diagnosed with bacterial meningitis. Key Lessons A patient’s return for care with worsening symptoms should trigger a diagnostic questioning protocol Fragmented patient care increases the need for concurrent communication among providers Clinical Sequence A 28-year-old man presented to Urgent Care with complaints of right ear pain and right-sided facial paralysis. At this visit, impacted ear wax was...
This case study was made available to MIEC through our partnership with CRICO. It was written by Lisa Heard, CRICO Description A patient suffers an infection when a biliary stent that should have been removed after three months is discovered still in place after 12 months. Key Lessons Determination among providers regarding accountability for patient follow-up is essential to prevent gaps in care. The discharging provider must have systems in place to confirm that the subsequent provider received information needed to accurately care for the patient. Information transfer involves physicians, nurses, care managers, office personnel, and information technology staff. Unresolved...