Struck off for missed sepsis

Andrea Borondy Kitts borondy at MSN.COM
Thu Dec 14 09:59:24 UTC 2017


Totally agree - decision support needs to be part of the physician work flown for it to be effective. The American College of Radiology has several initiatives in this area, one of these is ACR Assist https://www.acr.org/Practice-Management-Quality-Informatics/Informatics/Structured-Content

It does not include full AI diagnostic capability but may serve as a frame work for incorporating ISABEL for example, into physician work flow.

Andrea Borondy Kitts MS, MPH
Lung Cancer & Patient Advocate
Patient Outreach & Research Specialist
Lahey Hospital & Medical Center
borondy at msn.com<mailto:borondy at msn.com>
860-682-3606
@findlungcancer

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On Dec 13, 2017, at 8:50 PM, Edward Hoffer <ehoffer at GMAIL.COM<mailto:ehoffer at GMAIL.COM>> wrote:

What this says is that decision support systems need to be automatically invoked without the need for the clinician to ask for them.  In today's world, with most records electronic, the patient's data can be automatically extracted and run through a DSS (ISABEL and DXplain offer similar results). We have to get away from the model in which doctors recognize they need help and seek it out and move to one in which carefully thought out advise is "pushed" to the clinician.
Edward Hoffer MD

On Wed, Dec 13, 2017 at 12:25 PM, Jason Maude <jason.maude at isabelhealthcare.com<mailto:jason.maude at isabelhealthcare.com>> wrote:
This story gives a rather chilling spin on a case of delayed diagnosis of sepsis and subsequent malpractice case in the UK. The GMC (regulates doctors in the UK) has decided the doctor should be struck off but hundreds of doctors have rallied around to her support. Is this a case of doctors closing ranks or has her treatment been unfair punishing her as an individual while there were several systemic issues?

My initial reading reminds me of Captain Sully when the air accident investigators assume that he should have made an instant decision to try and get to La Guardia….

The Daily Mail article gives the background http://www.dailymail.co.uk/news/article-5146713/Doctors-rally-against-efforts-strike-Bawa-Garba.html<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.dailymail.co.uk%2Fnews%2Farticle-5146713%2FDoctors-rally-against-efforts-strike-Bawa-Garba.html&data=02%7C01%7C%7C5bb5cc4ec0cb4c56fabe08d542950098%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636488130078889342&sdata=yvuhFhwFsPUym1r8jLbQeDoNTgOFTAStU%2BHNzLIrXj4%3D&reserved=0> and I have attached the actual Tribunal report.

This blog in the BMJ and article in the New Statesman give a more ‘medical’ view:

http://blogs.bmj.com/bmj/2017/12/08/rachel-clarke-hadiza-bawa-garba-could-have-been-any-member-of-frontline-staff-working-in-todays-overstretched-nhs/<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fblogs.bmj.com%2Fbmj%2F2017%2F12%2F08%2Frachel-clarke-hadiza-bawa-garba-could-have-been-any-member-of-frontline-staff-working-in-todays-overstretched-nhs%2F&data=02%7C01%7C%7C5bb5cc4ec0cb4c56fabe08d542950098%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636488130078889342&sdata=DS23yWNBjFU6k%2BPE14J%2BTuxsme%2Bcgxi4%2BGIll3wH2As%3D&reserved=0>

https://www.newstatesman.com/politics/health/2017/11/case-hadiza-bawa-garba-should-worry-every-doctor<https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.newstatesman.com%2Fpolitics%2Fhealth%2F2017%2F11%2Fcase-hadiza-bawa-garba-should-worry-every-doctor&data=02%7C01%7C%7C5bb5cc4ec0cb4c56fabe08d542950098%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636488130078889342&sdata=1eEB5qQZhK3Zwq0bW21%2BK9%2Blwhul8aygBUGjuN5L%2FaQ%3D&reserved=0>


Dr Hadiza was obviously under huge pressure that day covering 3 separate units. The hospital later admitted to finding several systemic issues in their investigation. The GMC representative said that she should have had sepsis in mind as a diagnosis. Her initial diagnosis was gastroenteritis.

Is this a case where the clinician was just so busy and couldn’t be expected to do anything else or the health system, knowing that dx mistakes will happen when it’s so busy, should require the clinician to work up a differential?

I have attached 2 screen shots from a DDx tool with first showing the presenting symptoms of ‘diarrhoea, vomiting and difficulty breathing’ and then a 2nd screen shot with the presenting symptoms and the blood gas result showing high lactate. As you see, sepsis appears in 2nd position with just the presenting features and 1st with high lactate.
Does a tool like this help a clinician to be able to think more broadly and clearly while under pressure or does it hinder?

She was clearly under huge pressure so it would obviously be hard to think calmly but a DDx tool that is quick and easy to use could just possibly have triggered her to suspect sepsis which would certainly have changed how she managed the patient subsequently.

So, it’s a question of either too busy to do a DDx or so busy that must do a DDx? What are your views?

Regards
Jason


Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886<tel:+44%201428%20644886>
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