Version June 2024
| Diagnostic process | Representative case |
| Patient-clinician encounter | Access – A patient with underlying autoimmune disease begins experiencing shortness of breath. Worried about COVID-19 exposure if she were to go to the emergency department, she instead awaits an urgent care appointment, but has a cardiac arrest due to a massive pulmonary embolism. History – A patient describes worsening spasticity of his right upper extremity over the course of weeks. However, the team fails to appreciate this subacute time course, attributing his symptoms to a history of traumatic brain injury as opposed to the missed new cervical myelopathy. Physical examination – A patient presents with sepsis of unclear etiology. It is only after admission that a team member does a foot evaluation and recognizes wet gangrene, leading to urgent amputation. |
| Performance and interpretation of diagnostic tests | Ordering – A patient presents with symptoms concerning for tuberculosis. Three AFB smears are ordered, but a PCR is not. The smears are negative, and the patient is discharged with a diagnosis of community-acquired pneumonia only to be readmitted with progressive pulmonary tuberculosis. Performance – A patient is admitted with lower-extremity weakness. A lumbar puncture is ordered for evaluation of Guillain-Barré syndrome, but is not performed for >24 hours. Shortly after the procedure and prior to definitive treatment, the patient suffers cardiopulmonary complications of Guillain-Barré syndrome. Interpretation – A hospitalized patient with recent intraabdominal vascular surgery experiences abdominal pain. An abdominal radiograph is obtained and read as normal by the overnight team. The final read in the morning indicates portal venous gas reflecting necrotizing bowel. The patient decompensates and dies. |
| Team-based care, referrals, and consults | Consultation – A patient recently started on anticoagulant therapy is found to have worsening anemia. A gastroenterology consultation is not obtained as the anemia is attributed to chronic disease and repeated phlebotomy. The patient subsequently develops melena and on endoscopy is found to have a bleeding peptic ulcer. |
| Monitoring of patient or information over time | Monitoring over time – A patient is admitted with pericarditis and moderate effusion. The patient progressively develops worsening tachycardia that goes unrecognized by the primary team, resulting in arrest due to tamponade. |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
