Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims
IMPORTANCE:. Although rapid treatment improves outcomes for patients presenting with sepsis, early detection can be difficult, especially in otherwise healthy adults. OBJECTIVES:. Using medico-legal data, we aimed to identify areas of focus to assist with early recognition of sepsis. DESIGN, SETTING...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-02-01
|
| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000841 |
| _version_ | 1797894212482498560 |
|---|---|
| author | Heather K. Neilson, MSc, GDip Jacqueline H. Fortier, MSc PJ. Finestone, RN, CPPS Catherine M. Ogilby, RN, BScN Richard Liu, MCS Eileen J. Bridges, MD, MSc, CCFP Gary E. Garber, MD, FRCPC, FACP |
| author_facet | Heather K. Neilson, MSc, GDip Jacqueline H. Fortier, MSc PJ. Finestone, RN, CPPS Catherine M. Ogilby, RN, BScN Richard Liu, MCS Eileen J. Bridges, MD, MSc, CCFP Gary E. Garber, MD, FRCPC, FACP |
| author_sort | Heather K. Neilson, MSc, GDip |
| collection | DOAJ |
| description | IMPORTANCE:. Although rapid treatment improves outcomes for patients presenting with sepsis, early detection can be difficult, especially in otherwise healthy adults.
OBJECTIVES:. Using medico-legal data, we aimed to identify areas of focus to assist with early recognition of sepsis.
DESIGN, SETTING, AND PARTICIPANTS:. Retrospective descriptive design. We analyzed closed medico-legal cases involving physicians from a national database repository at the Canadian Medical Protective Association. The study included cases closed between 2011 and 2020 that had documented peer expert criticism of a diagnostic issue related to sepsis or relevant infections.
MAIN OUTCOMES AND MEASURES:. We used univariate statistics to describe patients and physicians and applied published frameworks to classify contributing factors (provider, team, system) and diagnostic pitfalls based on peer expert criticisms.
RESULTS:. Of 162 involved patients, the median age was 53 years (interquartile range [IQR], 34–66 yr) and mortality was 49%. Of 218 implicated physicians, 169 (78%) were from family medicine, emergency medicine, or surgical specialties. Eighty patients (49%) made multiple visits to outpatient care leading up to sepsis recognition/hospitalization (median = two visits; IQR, 2–4). Almost 40% of patients were admitted to the ICU. Deficient assessments, such as failing to consider sepsis or not reassessing the patient prior to discharge, contributed to the majority of cases (81%).
CONCLUSIONS AND RELEVANCE:. Sepsis continues to be a challenging diagnosis for clinicians. Multiple visits to outpatient care may be an early warning sign requiring vigilance in the patient assessment. |
| first_indexed | 2024-04-10T07:05:23Z |
| format | Article |
| id | doaj.art-a93d43e46e9c443b94120d1f4b3533fb |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-10T07:05:23Z |
| publishDate | 2023-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-a93d43e46e9c443b94120d1f4b3533fb2023-02-27T09:01:18ZengWolters KluwerCritical Care Explorations2639-80282023-02-0152e084110.1097/CCE.0000000000000841202302000-00002Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal ClaimsHeather K. Neilson, MSc, GDip0Jacqueline H. Fortier, MSc1PJ. Finestone, RN, CPPS2Catherine M. Ogilby, RN, BScN3Richard Liu, MCS4Eileen J. Bridges, MD, MSc, CCFP5Gary E. Garber, MD, FRCPC, FACP61 Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada.1 Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada.1 Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada.1 Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada.1 Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada.1 Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada.1 Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada.IMPORTANCE:. Although rapid treatment improves outcomes for patients presenting with sepsis, early detection can be difficult, especially in otherwise healthy adults. OBJECTIVES:. Using medico-legal data, we aimed to identify areas of focus to assist with early recognition of sepsis. DESIGN, SETTING, AND PARTICIPANTS:. Retrospective descriptive design. We analyzed closed medico-legal cases involving physicians from a national database repository at the Canadian Medical Protective Association. The study included cases closed between 2011 and 2020 that had documented peer expert criticism of a diagnostic issue related to sepsis or relevant infections. MAIN OUTCOMES AND MEASURES:. We used univariate statistics to describe patients and physicians and applied published frameworks to classify contributing factors (provider, team, system) and diagnostic pitfalls based on peer expert criticisms. RESULTS:. Of 162 involved patients, the median age was 53 years (interquartile range [IQR], 34–66 yr) and mortality was 49%. Of 218 implicated physicians, 169 (78%) were from family medicine, emergency medicine, or surgical specialties. Eighty patients (49%) made multiple visits to outpatient care leading up to sepsis recognition/hospitalization (median = two visits; IQR, 2–4). Almost 40% of patients were admitted to the ICU. Deficient assessments, such as failing to consider sepsis or not reassessing the patient prior to discharge, contributed to the majority of cases (81%). CONCLUSIONS AND RELEVANCE:. Sepsis continues to be a challenging diagnosis for clinicians. Multiple visits to outpatient care may be an early warning sign requiring vigilance in the patient assessment.http://journals.lww.com/10.1097/CCE.0000000000000841 |
| spellingShingle | Heather K. Neilson, MSc, GDip Jacqueline H. Fortier, MSc PJ. Finestone, RN, CPPS Catherine M. Ogilby, RN, BScN Richard Liu, MCS Eileen J. Bridges, MD, MSc, CCFP Gary E. Garber, MD, FRCPC, FACP Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims Critical Care Explorations |
| title | Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims |
| title_full | Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims |
| title_fullStr | Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims |
| title_full_unstemmed | Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims |
| title_short | Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims |
| title_sort | diagnostic delays in sepsis lessons learned from a retrospective study of canadian medico legal claims |
| url | http://journals.lww.com/10.1097/CCE.0000000000000841 |
| work_keys_str_mv | AT heatherkneilsonmscgdip diagnosticdelaysinsepsislessonslearnedfromaretrospectivestudyofcanadianmedicolegalclaims AT jacquelinehfortiermsc diagnosticdelaysinsepsislessonslearnedfromaretrospectivestudyofcanadianmedicolegalclaims AT pjfinestonerncpps diagnosticdelaysinsepsislessonslearnedfromaretrospectivestudyofcanadianmedicolegalclaims AT catherinemogilbyrnbscn diagnosticdelaysinsepsislessonslearnedfromaretrospectivestudyofcanadianmedicolegalclaims AT richardliumcs diagnosticdelaysinsepsislessonslearnedfromaretrospectivestudyofcanadianmedicolegalclaims AT eileenjbridgesmdmscccfp diagnosticdelaysinsepsislessonslearnedfromaretrospectivestudyofcanadianmedicolegalclaims AT garyegarbermdfrcpcfacp diagnosticdelaysinsepsislessonslearnedfromaretrospectivestudyofcanadianmedicolegalclaims |