23:00hrs: An unfortunate 49 year old lady with paraplegia is brought to the ED for necrotic tissue found and an area of erosion in her vagina secondary to a chronic indwelling foley catheter.
15:00hrs: My Attending and I are paged to the ED for a new admission.
15:10hrs: We arrive, get a quick snapshot of our new Pt from the ED doc coordinating the care of this pt, enter the cubicle.
15:11hrs: "Grreat, more doctors! What are you two here for?!"
My Attending: Let me introduce myself first. Which he does, and then me. Next, he proceeds to probe as to why they "attacked" us and appeared so distraught.
The pt was lying in bed almost in tears, her sister at bedside ready to crack skulls. They open up to us by saying she's been here almost 16 hours, no one person has maintained any continuity of explanations or kept them abreast of why she was being held their in a holding pattern. She's had 2 ED docs, 2 surgery residents, 1 urology Attending, multiple CNA's, and Nurses, a Medical Attending, multiple CT's and an Ultrasound of her hip, not to mention 2 new Docs (my Attending and myself) all within that span of time. Without any clear explanation from anyone in this whole ordeal. Until my Attending entered the picture...
We apologize to them for what has been a huge amount of undue stress and frustration. I track down some tissues for her as my Attending explains his plans and goals to rectify this situation in an expedited fashion as long as they are willing to give him time to do so. They agree "what's the damn difference in waiting more time".
15:15hrs: ED doc is frustrated by my Attending's probing and obvious frustration with the lack of continuity of care and extreme discordance in communication afforded to this unfortunate lady and her family. The ED director and ED charge Nurse are notified. The Surgical Attending is identified, the Urology Attending is called. The EMR is scanned by my Attending for pertinent data. We go to Radiology to get more information regarding the interpretation of the imaging studies.
Conflicting interests are identified. The Urologist stands by his position that the patient does not need to be admitted. Which is counter to what the original ED attending feels is best. A general surgical consult is re-ordered due to a question of an abscess/phlegmon is read by Rads. Then the case is passed off to ED attending #2. Who is going by the first ED doc and the desire to get further surgical involvement. More studies were ordered. More confusion for the patient. A surgical resident reviews the data, presents his assessment to the on-call Attending (who, ironically, knows the pt very well) and plays it off as something that does not warrant the Attending's time as Urology already recommended no admission, no further intervention at this time. But, no one communicated this to the patient or her family. She was punted back and forth. Medicine was originally consulted to admit her but they deferred pending Surgery's input. Many hours passed.
15:45hrs: We spoke with Urology, Radiology, Patient relations, the ED Admin folks, Surgery Chief Resident, and ultimately the Surgery Attending who was finally pulled out of the OR. The ED doc deferred to my Attending to orchestrate the final outcome of this situation.
16:15hrs: The Surgeon came in, examined her, and gracefully diffused the situation as best as he could considering the whole series of events and miscommunications that took place. She was extremely relieved to see him and get his final blessings that she could finally go back to her Nursing Home and did not indeed have an infection in her hip nor did she need to be admitted after all of this drama. She hugged him, and thanked him. She and her family thanked all of the ED admin folks and even my Attending for making a terrible situation somewhat right in the end.
16:45hrs: The EMTs arrive to take her back to her Nursing Home.
17:00hrs: She finally leaves the hospital.
What went wrong?
What could have been done better?
These are just a couple of questions we asked those involved both directly and indirectly with this case. Many more can be batted about. Sadly, this is not the first time this lady had a negative experience here. Hopefully it is this last. Only time will tell.
No comments:
Post a Comment