This month we look at a case where clinicians made an assumption based on a patient’s past history without really examining the current situation.  

The patient, 41-year-old Ms P, was a frequent visitor to her local emergency department (ED), with a history that included migraine headaches. One morning, Ms P was brought into the ED by ambulance, with complaints of headache, nausea and vomiting. The EMT team documented that Ms P had a headache, and one made some casual “here we go again” remark to the triage nurse.

The triage nurse noted that the reason for the ED visit was headache, and she noted that the patient was ‘sleepy’ and ‘refusing to talk.’ A short while later, Ms P was examined by Dr E, the emergency medicine attending physician. As Dr E examined her, the patient vomited a small amount of bile. A neurology exam was ordered and was noted to be within normal range, however neither the doctor or the nurse included a description of the patient’s headache or other details of her exam in the hospital record.

Ms P was given a diagnosis of migraine within three hours of her arrival by ambulance. After the diagnosis, no further testing or evaluation of her condition was ordered. She was given an anti-nausea medication and pain medication and was discharged.

During the patient’s discharge, the nurse noted in the file that Ms P was refusing to sit up. “Patient won’t sit up,” she wrote. The patient was wheeled to the waiting room in a wheelchair where she was discharged to a family member.

Later that same day, the patient collapsed at home and was taken to another hospital. At the second hospital, imaging was done which revealed that Ms P was suffering a subarachnoid hemorrhage from a ruptured aneurysm. The patient required a long hospital stay and suffered complications. Ultimately, she was left with severe permanent cognitive deficits.

On her behalf, the patient’s family brought a lawsuit against the ED attending physician, the two nurses who treated the patient, and the hospital, alleging that the required standard of care had been breached by discharging the patient with unresolved headache and vomiting.

The defendant doctor, nurses and hospital administrator met with their medical malpractice insurance company’s defense attorney to discuss the case.

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