Auntie-D Posted October 11, 2011 Share Posted October 11, 2011 (edited) Firstly, hello!! I'm new here and normally lurk around the Transfusion Forum but I have a multidisciplinary question...Scenario...62 YO male, clinical data - sepsis, 4 day H/O SOB. Tests requested @ 22:30 - U&E, LFT, FBC, Troponin I, Glucose. Results - Glucose 1.2, U&Es pretty much shot, Trop I 0.14, FBC Slightly raised neutrophils, normal platelets. The patient has arrested twice at this point but seems to have stabilised. Tests requested @ 01:30 - U&Es LFT, Amylase, FBC, glucose, Coag Screen. Results - Clucose 8.8, U&Es still shot, amylase borderline raised, FBC shows platelets of 89 fallen from 452 (sample not clotted), PT 17 seconds, APTT 45 seconds and fibrinogen was at the very low end of normal.My first thought was DIC and did a D-dimer immediately which came out at 28,000. I took the printed reports to A&E and discussed with the available medic the possibility of DIC and possible requirements for blood products. I hung around the laboratory for half an hour until I received a call telling me it was OK to go home (non-residential on-call). I questioned the lack of a request for products and they just said 'it's not needed'.Upon coming into work this morning I discovered that the patient had died and to to it off they had thrombolysed him! There is now some debate as to whether it is going to be a simple post mortem or whether there will be further inquiry. The medic is claiming that the interpretation of the D-dimer result was that the patient was having a massive PE, despite me discussing with them DIC. The consultant is claiming that the D-dimer result was not requested and confused medical staff and confounded the error.I know with the presentation the patient had little chance of survival and that I acted in good faith, I'm just a little concerned of legal action. What do you think? Edited October 11, 2011 by donellda per poster request Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 11, 2011 Share Posted October 11, 2011 Personally, I don't think that you have anything to worry about.What you did was to follow a professional idea (which I, too, would have done) that may well have helped the clinician to make a diagnosis, or to rule out a diagnosis. It is NOT your fault if the clinician was confused by your results. If he/she did not understand the results, he/she SHOULD have discussed them with his/her Consultant, not just blundered along. Link to comment Share on other sites More sharing options...
Auntie-D Posted October 11, 2011 Author Share Posted October 11, 2011 Thanks Malcolm. I'm just stunned that they are pulling the 'We didn't ask for the test and the results so the results were misinterpreted'. Never mind the fact that the patient was in severe sepsis so they should have asked for the test themselves anyway...But after discussion about DIC for them to interpret the results as PE just astound me. When is a PE D-dimer result ever as high as 28k? ** hum...Even without them thrombolysing him, I don't think he'd have made it - he was a very poorly chap Edit - I wasn't swearing... darned American sites Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 11, 2011 Share Posted October 11, 2011 AS you say, he was really poorly, and may well have died anyway, but to pull the blank, blank "It's your fault" card is unforgiveable. Link to comment Share on other sites More sharing options...
SMILLER Posted October 11, 2011 Share Posted October 11, 2011 I think if my boss or his boss or his boss found out I was posting stuff like this on a public forum, even anonymously, I would be in real trouble! Link to comment Share on other sites More sharing options...
Bill Posted October 11, 2011 Share Posted October 11, 2011 By posting this info on a website, by US standards, you have made ALL the mentioned laboratory information, and discussions with clinicians discoverable. That is, any private conversations and lab tests are now public and can be used against you or the clinician or the institution. Again--By US standards. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted October 11, 2011 Share Posted October 11, 2011 I agree, we do have to be careful, but......... Link to comment Share on other sites More sharing options...
Auntie-D Posted October 11, 2011 Author Share Posted October 11, 2011 Have asked the mods to anonymise further - can't edit my own thread... Link to comment Share on other sites More sharing options...
eric1980 Posted January 7, 2012 Share Posted January 7, 2012 We are all scientists here, and by posting in this forum, we should be all out for the science instead of legal and corporate opportunities... Hope the users here know the right thing to do, or not to do.Hi, Malcolm. Used to see you often in BBT. After a couple of years since I stopped posting, you are still around! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted January 7, 2012 Share Posted January 7, 2012 Yep, still here! Link to comment Share on other sites More sharing options...
Eagle Eye Posted January 7, 2012 Share Posted January 7, 2012 Someplaces if your upper administration knows regarding this, you could be in trouble for performing tests which was not ordered ....and informing the floor ...could be even major problem....I agree with some of the posters that we should not be worried about legal actions as we are strickly discussing these cases to expand our knoweldge base......Some people take it in different way so we have to be very careful when we are posting such cases. Link to comment Share on other sites More sharing options...
Eoin Posted January 9, 2012 Share Posted January 9, 2012 I agree, I have made the point before in the BB Forum re a case about scientist negligence. If you are likely to be a witness or defendant (heaven help us) in any litigation, the less you post on public forums, the better. I was giving evidence on behalf of a laboratory I was manageing in Oz some years ago, and was amazed at the knowledge the defendant's brief had - still pondering where he got some of it. So please do be careful when discussing such cases - anonymise it to a suggested possible scenario if you like - ask a friend at another hospital distant from you to post it online and join the discussion if you like.CheersEoin :cool: Link to comment Share on other sites More sharing options...
joannef Posted January 15, 2012 Share Posted January 15, 2012 ... as high as 28k? ** hum...Edit - I wasn't swearing... darned American sitesso funny! I used to use Net Nanny when my son was small & it auto-filtered even H.u.m.p.hrey Bear (kid's character) because of those offending first 4 letters!!keeping a sense of humour ... Link to comment Share on other sites More sharing options...
Pavel Dmitrievich Posted July 13, 2012 Share Posted July 13, 2012 Reading the full spectrum of the replies concerning this topic has been very depressing. I started my lab career in the 1960s. Obviously, I'm nearing retirement, and very glad of it. The system is no longer being driven by care for human health and safety, but run by lawyers and profit-takersall of whom are only too eager ruin the life of anyone else in order to make a buck. I'm disgustedby the way we're made to work, and will be very glad to no longer be a part of it. Link to comment Share on other sites More sharing options...
David Saikin Posted July 23, 2012 Share Posted July 23, 2012 In the USA scenarios like these depend on the size/type of facility you work in . . . Having worked in a large University Hospital - I would have been terninated immediately for performing testing without an MD's orders (practicing Medicine without a license). In the small facility I am in now it is expected that I will f/u results with additional testing which I deem necessary to provide pertinent info to the attending MD. Auntie - I think your actions were prudent. Link to comment Share on other sites More sharing options...
lalamb Posted July 25, 2012 Share Posted July 25, 2012 Our pathologist also stands by "techs can't order tests 'cus that's practicing medicine". Of course, if we run a test in error / mistake or a partial panel is ordered ,and we get a critical results, we are obligated to inform the provider. Regarding discussing cases, if no names (and I guess cities) are used, isn't that sufficient to protect everybodys HIPPA rights? This is a professional discussion site. Link to comment Share on other sites More sharing options...
SMILLER Posted July 30, 2012 Share Posted July 30, 2012 It seems to me there are at least two ways for techs to initiate test orders without getting into trouble (when preliminary results indicate follow-up needs to be done ASAP). The most common is to have a pathologist-approved protocol for reflex testing, such as ordering and reporting antibody panel/ID results when a screen is positive. The other is to simply call the ordering physician (or pathologist) with critical preliminary results and ask for futher orders.Scott Link to comment Share on other sites More sharing options...
tricore Posted August 8, 2012 Share Posted August 8, 2012 I agree, I have made the point before in the BB Forum re a case about scientist negligence. If you are likely to be a witness or defendant (heaven help us) in any litigation, the less you post on public forums, the better. I was giving evidence on behalf of a laboratory I was manageing in Oz some years ago, and was amazed at the knowledge the defendant's brief had - still pondering where he got some of it. So please do be careful when discussing such cases - anonymise it to a suggested possible scenario if you like - ask a friend at another hospital distant from you to post it online and join the discussion if you like.Eoin :cool: Were they smart enough to request it through court order? Link to comment Share on other sites More sharing options...
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