This case study was made available to MIEC through our partnership with CRICO. It was originally written by Margaret Janes, JD,RN, CRICO. Description A 41-year-old woman presented to the ED with a headache; she was treated and discharged within three hours with a diagnosis of migraine. Later the same day, she had an acute event. A CT revealed a subarachnoid hemorrhage from a ruptured aneurysm. Key Lessons Each provider owes it to the patient to make an independent assessment. Effective bias can narrow a clinician’s judgment and consideration of a patient’s complaints. Clinical Sequence A 41-year-old woman with a history...
This case study was made available to MIEC through our partnership with CRICO. It was written by CRICO Staff. Description A newborn died shortly after her birth, which was complicated by prolonged labor and a delayed diagnosis of chorioamnionitis. Key Lessons Determination for consultation in-person versus remote should be criteria-based. Prolonged labor without significant progress must trigger assessment by a (clinical) third-party. Unresolved concerns (e.g., maternal fever, fetal tracings, stagnant dilation) have to be regularly assessed and the care plan adjusted accordingly. Clinical Sequence A morbidly obese 26-year-old in the 41st week of her first pregnancy was admitted to Labor...
Opioid Treatment For Sleep Disorder Did Not Consider Patient’s Overall Medication Risks
This case study was made available to MIEC through our partnership with CRICO. It was written by Barbara Szeidler, RN, BS, LNC, CPHQ, CPPS, CRICO Description A 38-year-old woman with a history of suicide attempts and an Ativan prescription from her psychiatrist, dies of an overdose after being prescribed Oxycodone by a sleep specialist. Key Lessons Patients with complex histories and needs benefit from ongoing coordination among caregivers. Selection of opioids for treatment requires patient-specific clinical scrutiny. When prescribing opioids, assessing the risks of all medications the patient may be taking, and close monitoring, is critical to patient safety. Clinicians...
Narrow Focus Fogs Opportunity for Timely PE Diagnosis
This case study was put together by our partners at CRICO and was written by Melissa A. DeMayo, CRICO Description A 55-year-old patient died of a pulmonary embolism (PE) one week after an urgent care visit. Key Lessons A narrow diagnostic focus can fog the need for additional assessment. Fragmented medical records can challenge multi-specialty care. Clinical Sequence A 55-year-old woman with a history significant for obesity, hypertension, asthma, and anxiety presented to Urgent Care complaining of shortness of breath, hemoptysis, and persistent cough for three days. She reported pain (6-7/10) in her posterior right shoulder and right calf. Nursing...
This case study was put together by our partners at CRICO and was written by Katherine Zigmont, BS, RN, CPPS, CRICO Description A 34-year-old male suffered complications of untreated pyelonephritis, including sepsis and multiple amputations, after spending 17 hours in the Emergency Department (ED). Key Lessons Boarding of critically ill patients is associated with increased mortality Abdominal pain coupled with an elevated white blood cell count and fever elevates consideration of urgent testing/imaging Weekend and off shift resources, e.g., a radiologist to read a CT scan, cannot be underappreciated Trainees require vigilant supervision Direct communication between ordering providers and consultants...