Dialogue Volume 15 Issue 1 2019 - Page 40

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-