Doctors Fail to Follow Up on Lab Tests Indicating Infection

This case involves an elderly male patient that was admitted to the hospital for a suspected UTI related to indwelling catheter use. A urine culture was ordered by a nurse practitioner, however the patient was discharged before the results were reviewed. It was later revealed that the test results were sent to the wing of the hospital in which the patient was staying, however they were not brought to his care providers. A few days after being discharged from the hospital the patient presented to the emergency room with signs of a worsening infection. The patient required multiple surgeries in order to repair damage done by the untreated infection, and continues to suffer from ongoing urinary tract dysfunction.

Question(s) For Expert Witness

1. How frequently do you treat patients like the one described in this case?

2. In the presence of a patient with suspected UTI, who is usually responsible for following up on the urine culture results?

3. What are the discharge criteria for a patient with symptoms consistent with the diagnosis of UTI?

Expert Witness Response E-033816

I care for patients with UTIs frequently in the ED, Urgent Care, and through my internal medicine position. In all 3 settings I assess, perform differential diagnoses and order appropriate diagnostic studies which would generally include a UA and, if positive, a urine culture to follow. Treatment generally begins after a positive UA, although in some circumstances it may be delayed depending on the urine culture. Other conditions can cause symptoms commonly associated with UTI symptoms, thus diagnostic testing is important if the diagnosis is not immediately clear. The person responsible for follow up on the diagnostic tests, including a urine culture is either the provider who ordered the test, another provider of the care team when the ordering provider is not available or another designated provider. The specific person depends on the setting, the resources, and the facility's established procedure for follow up on resulted labs.