5 ms·

medical opinion is that sepsis was not the cause of death despite the family's insistence. it is likely a rare condition that the doctors missed. this case is

• franktankbank 1y ago
  Read all the issues with his diagnosis. One way or another the staff wasn't doing what the record says they did. How could you possibly get to the diagnosis if the tests your claim ordered was never done?
  • didntknowyou 1y ago
    did you read the article? i have a medical background and his hematology results does not support sepsis. the family pointing blame at the hospital for ignoring the sepsis automated warning is barking up the wrong tree and probably why the hospital ignored them. not saying the hospital is faultless because they clearly failed in this case but as in any courtroom if you charge a criminal with the wrong crime you are bound to lose.
    • in_cahoots 1y ago
      I think the real implications are much more chilling. As much as we like to believe otherwise, there is always a chance that a seemingly-healthy college kid will drop dead of something that even the best doctor wouldn't have anticipated. And as much as we would like to believe otherwise, the modern healthcare system is riddled with problems that no technology or checklists will fix. It doesn't take someone's death to verify this- just go read your own charts and discharge papers. Even for something relatively routine there are bound to be inaccuracies. Doctors know this, which is why they spend so much time doing handoffs and interviewing patients. We pretend that the medical 'record' is infallible, helping to reduce the mental load on doctors while protecting them from liability. But as this case shows, the 'record' is both inaccurate and not useful in showing fault. It's a paper tiger. I'm not saying we should scrap the whole system, but I do think it needs to be examined in a data-driven manner.
      • fluoridation 1y ago
        What do you mean? Isn't record-keeping a data-driven practice?
        • in_cahoots 1y ago
          No. I can transcribe every interaction with 100% accuracy, but if those notes aren't used in any way it's not data-driven. This article shows that the notes are inaccurate, suggestions using the notes are routinely ignored, and that doctors and legal review think this process is acceptable. There is no professional or legal liability if the records are wrong. And yet if you talk to a medical professional they'll explain that the records are to establish a legal paper trail if anything goes wrong. Some executive(s) have been told that detailed medical records are the solution to so many problems in modern medicine. But they lack either the guts or the expertise to make sure that these systems are actually accomplishing what they set out to do.
          • fluoridation 1y ago
            >suggestions using the notes are routinely ignored Of course. The records are known to not be 100% accurate. Any conclusion you derive from them will be faulty. >There is no professional or legal liability if the records are wrong. Again, of course. In many cases it may not even be possible to show a record is incorrect. For example, if the record doesn't say a test was performed, but the patient insists that it was, is the record wrong, or is the patient mistaken? Or a doctor could incorrectly write down something that only he saw, such as a blood pressure value on a gauge. I would guess a key obstacle to eliminating all these inaccuracies is that doctors don't see strict record-keeping as actually useful in helping patients. Every minute that they're taking notes of dubious future utility is a minute they could spend seeing a patient.
            • riknos314 1y ago
              The real issue is the administration of the hospital sees every minute the doctors spend taking better records instead of seeing another patient as a loss of ability to bill someone's insurance for that time. I'm sure there's many doctors who would like to take better notes if they were allowed the time to do so. Maybe the case for better records reducing costs to insurance by assisting in prevention / early intervention is a path forward?
    • haskellshill 1y ago
      People die of missed sepsis all the time, so if you want to lean on your "medical background" to claim this was not the case, you better elaborate what exactly that background is
  • Bucket0fFire 1y ago
    I am an inpatient RN. This conversation is interesting for several reasons: laypeople, unless in hospital as a patient frequently, will have no idea how the "systems" in a hospital intertwine and work together - if we're lucky enough to have them do that. (I wish medical professionals had the energy to talk more about the minutiae of their work just so people better understood.) The "systems" I'm talking about are specialties and roles as well as computer this and technology that. Ethics taught to administrators as well as coders would change a LOT about what we are charting - fact is, hospitals are doing more today to cut costs and avoid liability than they are doing to put patients first. This is obvious just by the fact that they keep declaring they are putting patients first. Rule of thumb: the more the thing is advertised, the less likely it is true despite the understanding that THAT thing is extremely important to their target audience. (not to mention outcomes and statistics show who is getting good care and who is not -lots more to do with finances and financial resources than evidence-based practice, seems to me.) To the point of this article: While I'm charting, I get pop-ups CONSTANTLY. Most are from the software company wanting to give me a tour of the programs features while I'm literally just trying to find a note written by physical therapy, or chart vital signs - I would LOVE to have a proficient skill in navigating EPIC but no hospital where i've worked has given me training beyond the first week. No return to chart training after I've worked with their system for a while, later, when I would know what I'm looking to improve. Other pop-ups are for sepsis alerts as this discussion is about, or (for a RN) fall alerts or skin alerts... All the things that are part of my job and training to be regularly assessing. Here is my summary: What I have seen, for docs and especially for RNs is very obviously just micro-managing to insane degrees of interference, when what works to achieve the right process and best outcome is solid training, retraining, accountability by real people and with respect, and excellent leadership. I DID once work at a hospital where they had enough staff to follow up, answering questions staff had (nursing care or software hacks) and -most important- leadership that did not intimidate, and that could and would talk with the staff member not meeting standards, in real time, getting them past whatever hangup or misunderstanding gets in the way of excellent practice. Follow up and follow up again, with the attitude of teaching (versus punitive micro-management by those whose priority is the bottom line) and supporting the staff to do the right and best thing. Pop-ups and multiple clicks to say "ok" and "yes, I really do mean to do this thing" and "for real please confirm!" add too many wasted minutes, interrupting my thought processes every day day when seconds count for someone's life-saving treatment. I don't know if there is any other industry outside of medicine and nursing where the institution itself literally just adds one road block in front of another, keeping us from focusing and doing what our critical thinking and training have taught us to do. ...don't get me started on Moral Distress and Secondary Trauma because of ignorance around letting us care. . .
• codeulike 1y ago
  OK fair enough, but the detail in the article about the hospital information system and 'Note bloat' are still very interesting to me. I've seen stories like this before - when everything triggers an alert, people start ignoring the alerts. (edit: it was this story: https://medium.com/backchannel/how-technology-led-a-hospital-to-give-a-patient-38-times-his-dosage-ded7b3688558 https://medium.com/backchannel/how-technology-led-a-hospital... )
  • Fomite 1y ago
    Indeed, it's likely starting to treat for sepsis could very well trigger an antibiotic stewardship alert.
• jll29 1y ago
  It may be that the ER's rapid throughput meant they adhere to the heuristic quoted in the article "When you hear hoofbeats, think of horses, not zebras." -- Anon. (saying in medicine) whereas here, it was the (more rare) zebra, but nobody could take the time to do DD (differential diagnosis, i.e. to tease apart what can and cannot be the case).
  • starkparker 1y ago
    This is stated as the likely result in the article, complete with the quote. The article notes that the ER, at that stage of the visit, is not tasked with a diagnosis but deciding whether to admit to the hospital or discharge. The complaint is that, sepsis or not, horse or zebra, the symptoms presented were severe enough to warrant further tests (such as a chest x-ray, if for no reason other than to rule something out) as part of a hospital admission. Those tests might also have been inconclusive, and the patient might still have died, but it would have at least reflected the severity of what was presented. Instead, in a chaos of paperwork and a supervising physician who overruled every warning flag in favor of discharging the patient, the kid got sent back to die alone in his dorm room.
    • m_fayer 1y ago
      This article brought up the sickening memory of taking my frail elderly mom to the er with similarly severe-but-general symptoms. The er was crowded and the hospital was crowded. The er clearly couldn’t treat her beyond basics, she needed to be admitted and monitored. But, as a sympathetic resident told me before mysteriously disappearing “there’s no space upstairs, I’ll try to get your mom in somehow”. I worked with EHRs at the time and knew how to advocate. They kept trying to discharge my deeply ill mom without explanation and bumping into my objections, I was talking to a different nurse or social worker or resident every 3 hours round the clock. I felt scared to leave even for a short time lest they expel her. In the end, I needed to go home to sleep and they discharged her at 6am, and when I arrived they had her bundled up and already waiting to be taken home, shivering and ashen. All they told me was that there’s no diagnosis, no reason to admit her and no beds anyway, she just needs to rest and have fluids, try urgent care if needed. Multiple social workers sympathetically assured me and my mom’s aide that we were good people for being up to taking care of my mom at home, so they could tick a discharge box. We emphatically were not. In the end, eventually, she was ok. The experience was harrowing. Many people talked to me but no one engaged with us, the interest was clearly in getting my mom out. It felt cruel and uncaring. I’m surprised the article doesn’t address the “refusal to admit” angle. It used to be that you could admit patients for care and monitoring without a diagnosis, but this simply isn’t a thing anymore. So, deeply ill people who for whatever reason don’t have access to adequate care and monitoring from a caretaker at home are simply surrendered to their fate.
• notmyjob 1y ago
  It’s usually something rare, almost by definition.