Knowledge Library

Test delay blamed for woman’s colon cancer death

This case study was made available to MIEC through our partnership with CRICO. It was originally written by Maureen Burns-Johnson, BSN, RN.  Description A 46-year-old female died from ovarian and metastatic colon cancer two years after presenting to her PCP with a five-week history of constipation and rectal bleeding—symptoms that continued across several visits over a year and a half before she was diagnosed. Key Lessons A narrow diagnostic focus can contribute to delay in ordering necessary tests. Using algorithms, guidelines, decision, or support tools can lead to a more timely colon visualization or referral. Specialty practices need scheduling systems...

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A slip in protocol leads to a patient fall and a tragic outcome

This case study was made available to MIEC through our partnership with CRICO. It was originally written by Lisa Heard, MSN, RN, CGRN, CPHQ, CRICO. Description A patient, with a known falls risk, fell during a radiology exam and died from her injuries. Key Lessons Critical information about a patient’s risk status must be transferred during a transition of care. Training that demonstrates the risks of not following certain policies may prevent dangerous deviations. Clinical Sequence A 55-year-old female with multiple co-morbidities (hypertension, Type 2 diabetes and on dialysis for end-stage renal disease) was admitted to the hospital with a...

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Patient unaware of PSA testing, then cancer

This case study was made available to MIEC through our partnership with CRICO. It was originally written by Jessica Bradley, MPH, CRICO. Description A 52-year-old man was diagnosed with prostate cancer three years after a panel of lab results showed an elevated PSA that the patient never saw and his PCP inadequately followed. Key Lessons A system to track complete physical examinations at regular intervals allows the provider to thoroughly assess the patient's history and counsel for recommended cancer screenings. PSA testing should not be automatic. A successful process for working up abnormal lab results includes: communication of results to...

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Patient’s Migraine History Biases Diagnosis in ED

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...

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Overriding Drug Alerts Results in Patient Death

This case study was made available to MIEC through our partnership with CRICO. It was written by Kathy Zigmont, BS, RN, CPPS Description A 61-year-old female with a complex medical history died after being administered contraindicated medications. Clinical Events A 61-year-old female with a complicated medical history was admitted for an evaluation of a large right ventricular thrombus with Automatic Implantable Cardioverter Defibrillator (AICD) lead involvement. Her history included non-ischemic cardiomyopathy with ventricular tachycardia, an AICD placement, atrial fibrillation, and recurrent pulmonary emboli. The patient was also taking the antiarrhythmic Dofetilide (500mcg/day), which is associated with QT interval prolongation, a...

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