PRACTICE PARTNER
blood cultures identified E. fecaelis bacte-
remia. These results were communicated
to the ED, however, the patient was not
contacted.
On December 18, hours after sustaining a
fall, the patient presented again to Hospi-
tal A with symptoms similar to those from
his last visit. Blood culture results from
December 6th were reviewed
and the patient was admitted
to hospital with a diagnosis of
and bacteremia.
"Physicians must sepsis
The patient’s spouse requested
ensure that
that the patient be transferred
to Hospital B for further man-
they maintain
agement. He was transferred
an effective
to Hospital B on December
test results
22, 2015, where his condition
continued to deteriorate.
management
The patient died on January
system"
13, 2016 following a course of
illness that lasted approximately
seven weeks.
The immediate cause of death
was complications of endocarditis.
The Committee’s concerns
The course of this patient’s illness, includ-
ing his age, underlying illness (i.e. diabetes
mellitus), non-specific presentation, caus-
ative organism and annular abscess with
first-degree heart block, are typical of pros-
thetic valve endocarditis (PVE). Infective
endocarditis is recorded as the presumptive
diagnosis in the admission note on Decem-
ber 18 at Hospital A.
While the ED assessment on Decem-
ber 18, 2015 indicated knowledge of the
history of E. fecaelis bacteremia, the organ-
ism’s antimicrobial susceptibility was not
integrated in the immediate ED treatment
40
DIALOGUE ISSUE 1, 2019
plan; Levaquin was initially ordered, lead-
ing to a gap of 12 hours before ampicillin
and gentamicin were initiated.
The Committee found that while a
delayed diagnosis of PVE is not unusual,
a number of issues relating to the patient’s
care may have contributed to his death and
warrant further consideration. Throughout
its recommendations, the Committee cited
relevant CPSO policy.
1. Diagnostic test results
i) Notification of positive test results following
discharge from the ED at Hospital A.
Positive blood culture results were re-
ported back to the most responsible physi-
cian (MRP) in the ED at Hospital A. The
patient was not informed as his telephone
number was reportedly not readily available
to hospital staff at the time. There was no
evidence on the emergency record that the
laboratory had reported a positive result
post discharge.
“If the tests were taken in the ED and
a phone number is not readily available,
all efforts should be made to access the
patient’s contact information through the
patient’s family doctor, Teleheath Ontario,
the ambulance service or even the police
as appropriate,” stated the Committee’s
report.
According to CPSO’s policy on Test
Results Management, “physicians must
ensure that they maintain an effective test
results management system in order to
ensure that appropriate follow-up on test
results occurs in all of their work environ-
ments.”
Physicians are responsible for appropriate
follow up with the patient, in particular for
“taking action when in receipt of a clini-