Miscommunication Leads to Critical Delay in Care For Sepsis Patient

This case involves a male patient in his late twenties who was admitted to the defendant hospital with severe abdominal pain, fever, tachycardia and low blood pressure. The hospital immediately performed lab testing which showed a highly elevated white blood cell count as well as other abnormalities suggesting sepsis. However, the nurse and the doctor did not look at the lab results for several hours, when the CT report came back with evidence of kidney stones and fluid buildup in the patient’s kidneys. Despite these troubling findings, the patient was not seen by physicians for some time, as his nurses failed to communicate their concerns about the patient’s worsening condition to the doctors on-shift. Eventually, the patient was seen by a urologist, who diagnosed the patient with sepsis and initiated a stenting procedure as well as aggressive fluid therapy, however the patient lost both legs as a result of the delay in care.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case?

2. Given the information above, to the best of your knowledge, if care had been rendered quicker, would the outcome have been more favorable for the patient?

Expert Witness Response E-016836

I'm a critical care doctor and management of severe sepsis is a major part of my practice. I'm not a urologist but source control is an important aspect of managing sepsis and determining the need and timing for consulting surgeons or other specialist is also a routine aspect of my practice. Unfortunately, all I can say as far as an improved outcome for this patient with earlier intervention is maybe. Early diagnosis and treatment of severe sepsis is a major current quality improvement initiative. Data suggest that early (first 6 hours) management is critical for improving outcomes. This patient appears to have been under-resuscitated in this critical window. Earlier and more aggressive resuscitation with fluids and vasopressors followed by stenting or percutaneous drainage of his hydronephrosis may well have prevented his significant morbidity.