A 50-year-old woman underwent a breast biopsy on a Friday. Over the weekend she developed flu-like symptoms (nausea, diarrhea, headache, and fever). On Sunday, she called her breast surgeon, who referred her to her primary care physician (PCP).At 9:00 a.m., Monday, she presented to the PCP’s office and was noted to be hypotensive and unstable. The PCP accompanied her to the Emergency Department (ED).At 11:00 a.m., she was assessed and treated by an ED attending. After initial blood work, the patient was started on IV fluids. Laboratory results revealed elevated liver and renal function tests. A physical exam was performed; no assessment of the breast biopsy site was documented. At 12:30 p.m., the ED attending diagnosed possible hepatitis, and transferred care of the patient to the inpatient medical service. In order to minimize the patient’s wait, he bypassed the ED resident and dealt directly with the inpatient medical service. At 3:00 p.m., the ED attending signed the patient out to an oncoming ED physician, indicating that the patient was now under the care of the inpatient medical service. At 5:00 p.m., a first-year medical resident arrived reviewed the patient’s medical record. When a low dose of Dopamine failed to improve the blood pressure and urine output, the medical team decided to transfer the patient to the Medical Intensive Care Unit (MICU). A lack of MICU beds forced the patient to remain in the ED. According to hospital policy, the patient was again under the care of the ED until transfer. At 10:00 p.m., upon admission to the MICU, the patient was noted to be febrile and remained hypotensive; no assessment of the breast biopsy site was documented. The MICU resident diagnosed sepsis, and a decision was made to place a central line to rapidly administer fluids and medications. The patient arrested during line placement and remained unconscious. The next day (Tuesday), a Renal consult noted concern regarding the appearance of the breast biopsy site; a surgical consult (obtained at 5:00 p.m.) supported a diagnosis of infection. Without regaining consciousness, the patient died a week later of sepsis and toxic shock syndrome, triggered by an infection of the breast.
For this discussion:
450 to 500 words. Communicate the importance of risk management as it relates to patient safety in the delivery of quality health care. Identify the risks to patient safety and healthcare quality.
