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CASE STUDY: Improper Management of Bariatric Surgery Patient Leads to Suboptimal Outcome

CASE STUDY: Failure to Diagnose Pulmonary Embolism Results in Patient's Untimely Death

Case Details

A patient underwent laparoscopic Roux-en-Y gastric bypass. During the immediate postoperative days, the patient experienced tachycardia and significant abdominal pain. An abdominal computed tomography (CT) scan revealed fluid in the abdomen, but the results were not immediately relayed to the surgeon.

Over the next 2 days, the patient’s condition deteriorated, but neither the nursing staff nor the lab directly notified the surgeon about the critical CT scan results. Ultimately, the patient required surgery after developing respiratory distress, metabolic acidosis, septic shock, and acute renal failure.

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Bariatric Surgery Malpractice Allegations: What Claims Data Show, and Ways to Reduce Risk

CASE STUDY: Failure to Diagnose Pulmonary Embolism Results in Patient's Untimely Death

Obesity is a well-known health concern in the United States. Often referred to as an epidemic, obesity affects about 36 percent of U.S. adults — more than double the number affected just 30 years ago.1 Bariatric surgery has emerged as an effective treatment option for many individuals who suffer from obesity, and the number of these procedures has increased over the years.

With the rate of obesity on the rise and bariatric surgeries increasing, it logically follows that malpractice claims associated with these procedures also have increased. Just like other types of surgery, bariatric surgery carries a number of risks. However, the patient population seeking bariatric surgery presents unique challenges because of their physical health and comorbidities (e.g., heart disease, high blood pressure, diabetes, respiratory issues, sleep apnea, etc.), which often make these patients high risk.

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CASE STUDY: Failure to Diagnose Pulmonary Embolism Results in Patient’s Untimely Death

CASE STUDY: Failure to Diagnose Pulmonary Embolism Results in Patient's Untimely Death

The patient was a male in his late twenties who suffered from obesity, asthma, high blood pressure, and Crohn’s disease. He also had a recent history of surgical repair for a femur fracture. The patient visited his regular family medicine practitioner in October and was treated for rhinitis and sinusitis. His pulse oximetry reading at the time was 99 percent.

A month later, the patient presented to the practice again with complaints of shortness of breath, coughing, and right-sided back pain. At this visit, he saw Dr. M — another family medicine physician in the practice — for the first time. Dr. M ordered a stat chest X-ray, the results of which were negative. The patient’s pulse oximetry reading at this visit was 95 percent.

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Close Encounters of the Diagnostic Kind: Improving Provider–Patient Communication During the Diagnostic Process

Laura M. Cascella, MA

Close Encounters of the Diagnostic Kind: Improving Provider–Patient Communication During the Diagnostic Process

The model of the diagnostic team, proposed in the Institute of Medicine’s (IOM’s) pivotal report Improving Diagnosis in Health Care, relies strongly on close collaboration with patients/families as part of the diagnostic process. In its recommendation for implementing a team approach, the IOM notes “Health care professionals and organizations are responsible for creating environments in which patients and their families can learn about and engage in the diagnostic process and provide feedback about their experience.”1

Yet, even with this growing emphasis on patient engagement and collaboration, communication failures continue to be a top risk factor in diagnostic errors. Ten years of MedPro Group closed claims data show that communication issues are the second most common contributing factor in diagnosis-related malpractice claims, occurring in 33 percent of these cases — and these issues have remained persistent over the years.2

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Safety in Numbers: Improving Diagnosis Through Teamwork

Laura M. Cascella, MA

Safety in Numbers: Improving Diagnosis Through Teamwork

In recent years, numerous groups and individuals — including advocacy groups, researchers, healthcare providers, and others — have raised awareness and increased understanding about diagnostic errors, drawing attention to the profound effect that these errors have on patients, families, and clinicians.

Although exact numbers are not known, studies suggest that the diagnostic error rate is in the range of 5–15 percent, with variations across specialties.1 Dr. Hardeep Singh, a renowned expert on diagnostic errors and a reviewer for the Institute of Medicine’s (IOM’s) influential report Improving Diagnosis in Health Care, has estimated that 1 in 20 U.S. adults will experience a misdiagnosis every year — a staggering statistic.2 Further, diagnostic errors likely contribute to 40,000–80,000 patient deaths in the United States annually.3

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Data Insight: Opioid Treatment — Liability Risks in the Office Setting

It is nearly impossible to read or watch the news without mention of the opioid crisis. From patient addiction to death from overdosing, opioid abuse can have tragic outcomes. Further, when these unfortunate events are related to medical care, they can result in malpractice allegations against healthcare providers and organizations.

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Tips for Presenting a Patient With a Pain Management Contract

Pain management contracting is one strategy that healthcare providers can employ to help manage the risks associated with treating patients who take opioids. A pain management contract is a type of behavior contract, which is an agreement between a patient and healthcare provider or organization that defines expectations related to behavior, conduct, communication, and/or treatment. Using a pain management contract can help set standards and expectations in relation to a patient’s care, the provider–patient relationship, and appropriate use of opioid therapy.

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CASE STUDY: Patient Overdoses and Dies After Inappropriate Opioid Prescribing

The patient was a male in his late thirties with a history of significant orthopaedic injuries and a previous narcotic and heroin dependency. He presented to the emergency department (ED) at a rural critical access hospital with complaints of low back pain radiating down both legs. He was diagnosed with muscle spasms, treated with non-narcotics, and referred to a family medicine physician.

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