This case involves an elderly male patient who was discharged from a hospital emergency room despite having lab results consistent with sepsis. Although the patient’s lab results triggered the hospital’s “severe sepsis warning” in the electronic medical record, these notifications were only received by the nurse, not the doctor. The nurse did not verbally communicate the sepsis warning notification to the doctor because he assumed the doctor was already aware. As such, the doctor never saw or heard the warning and the patient was discharged. The patient returned to the emergency room within 48 hours after discharge in full septic shock. He suffered a stroke and ended up in a coma. An expert in hospital administration was sought to address the proper protocols for staff when a patient like this presents themselves to the emergency room.
Question(s) For Expert Witness
1. What are the proper protocols for staff when a patient like this presents themselves to the ER?
2. What type of training should nurses receive on a hospital's electronic medical record system, with specific regards to notifications?
Expert Witness Response E-026526
I teach an EHR healthcare administration course. It is not likely that administrative protocols are a major factor in this case, other than the electronic medical record alert, which is most likely a user-defined protocol based upon lab results and possibly vital signs. One system in particular, which allows user-defined alerts that are approved by hospital executives or by a committee at the hospital, is currently being replaced in many hospitals nationwide because it is not a good system. These type of medical record alerts can be overridden by the treating physician relatively easily, though they may require some justification and this type of documentation should be carefully sought in a careful review of the EHR. That being said, it is more likely that this case is one of negligence on the part of the treating ED physician. If the intent is to name the hospital as a co-defendant then it would imperative to review the relationship between the emergency medicine physician who treated the patient in the ED and the hospital. A significant majority of hospitals contract for ED physician coverage, and if this is true in this case, then the hospital would share equal liability for the adverse outcome. The hospital should not have sent a patient with sepsis home. It was clear to the EHR that this patient had sepsis, it was clear to the nurse that this patient had sepsis and it should have been clear to the ED physician. This patient should have been put on medication immediately and this demonstrates airtight negligence.
About the author
Victoria Negron
Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.
Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.
Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.
