The Hawaii Legislature and Governor Josh Green, MD, have enacted significant legislation impacting Hawaii physicians. For a broad report on healthcare legislation enacted, see the Hawaii Medical Association 2024 Legislative Report. Provider Orders for Life Sustaining Treatment (POLST) Effective immediately, this measure (SB 2529) amends the definition of “patient’s provider” initiating POLST orders by removing language that requires the provider to “examine” the patient. Entities testifying in support of the amended law noted that this “examination” requirement often resulted in delays in completing and/or updating a patient’s POLST, particularly for patients in hospice care. The amended law recognizes that “POLST...
Incomplete Record Review Delays Endocarditis Diagnoses
This case study was put together by our partners at CRICO and was written by Margaret Janes, CRICO Description A diagnosis of endocarditis was made 18 days after the patient, who had a (known) congenital bicuspid aortic valve, initially presented with fever and fatigue. Key Lessons When patients return with repeated complaints, consider other causes for symptoms Communicating with patients in ways not captured in their health records may contribute to missed information and assessment opportunities Develop triggers for when to bring patients to the office when they call with unresolved complaints Clinical Sequence A 43-year-old female saw her new...
This case study was put together by our partners at CRICO and was written by Margaret Janes, CRICO Description A diabetic patient being treated for a foot contusion suffers necrosis and requires a partial amputation. Key Lessons Engage patients in their care plan; do not assume patients understand or will comply with recommendations. Documentation in the medical record supports care provided at the time of a patient encounter. Clinical Sequence A 62-year-old male with a history of diabetes, neuropathy, and peripheral vascular disease presents to the ED after suffering for three days with a contused foot after a heavy box...
Breast Cancer Treatment Delayed 15 Months by Mishandled Radiology Report
This case study was put together by our partners at CRICO and was written by Melissa A. DeMayo, CRICO Description A 53-year-old patient experienced a 15-month delay in the treatment of cancer after breast biopsy. Key Lessons A fragmented medical record can lead to delays in care. Lack of a closed-loop system for tracking orders and results exposes critical diagnostic information to being lost. Clinical Sequence A 53-year-old woman presented to the internal medicine (IM) clinic for follow up after being evaluated in the Emergency Department for complaints of shortness of breath and atypical chest pain. Her medical history was...
Test Result Snafu Delays Cervical Cancer Diagnosis
This case study was put together by our partners at CRICO and was written by Jennifer Clair MacCready, Senior Patient Safety Program Director, AMC PSO Description A 32-year-old patient did not receive abnormal test results nor associated need for follow up, leading to a delayed diagnosis of cervical cancer. Key Lessons Closing the loop on referrals ensures patients receive appropriate follow up. Electronic systems should support clinicians and provide alerts for follow up. Ensure clinicians understand electronic health system processes and potential gaps. Clinical Sequence A 32-year-old female with a history of genital herpes had a physical exam and Papanicolaou...