Communication in Emergency Department Administration - A Life or Death Issue

Case Overview

This case study examines the tragic circumstances surrounding a young adult male who initially sought emergency medical attention due to physical assault resulting in left-sided pain.

After laboratory tests, he was discharged from the hospital. However, within 24 hours, these tests revealed an unidentified cardiovascular infection. This critical information was not communicated to the patient. Within a week, the individual returned to the emergency department (ED) in a severe condition and ultimately succumbed to the infection.

An autopsy later identified lymphocytic myocarditis as the cause of death. The management of this patient’s condition raises serious questions about whether the standard of care was maintained.

Questions to the Emergency Medicine expert and their responses

How often do you create and/or inform protocols surrounding laboratory findings conveyance to individuals with potentially life-threatening conditions?

As an expert with 25 years’ experience in rural emergency department administration, I can say that creating protocols for conveying laboratory results is done infrequently. Once established, these protocols usually remain unchanged unless there is a significant shift in process or practice.

Based on your experience, what procedural safeguards are typically in place to ensure that patients are aware of such laboratory results?

If laboratory results become available while the patient is still present in the ED, it falls upon the treating medical provider to communicate these findings directly to them.

If results come back after discharge, it becomes the responsibility of whichever provider is on duty when those results are ready. Electronic medical records notify us when culture or send-out lab test results are available.

Please describe your experience in emergency department administration in rural areas, if applicable.

I have extensive experience working in rural settings, having served as the medical director of a 7-bed emergency department for eight years.

About the expert

This expert is a board-certified family medicine physician with 25 years of experience, including significant work in emergency department administration. They have held roles as an urgent care physician and medical director at various healthcare institutions, demonstrating their extensive knowledge and practical experience in the field. Currently, they serve as an emergency department physician at a long-term care facility and an urgent care physician at a hospital and medical center, further solidifying their expertise in managing critical patient cases.