more effective discharge and community
follow-up for these complex care patients in
order to identify and treat the root causes of
illness before a severe event occurs,” stated
PSRC’s review. Enhanced communication
strategies between emergency departments
and primary care providers may help to
identify the need for elective assessment of
patients, including those whose management
is complicated by obesity.
The difficulty in finding a hospital to take
the patient also prompted the PSRC to
recommend that access to urgent care for
patients with morbid obesity should be coordinated and facilitated.
“Although not specifically stated as a reason
for declining to accept the patient at all of
the hospitals contacted, it would appear that
the patient’s morbid obesity contributed to
the difficulty in finding an appropriate bed,”
stated the PSRC’s report.
“Given the increasing segment of the
population who are within the obesity BMI
classification, it is important to address how
our health system is resourced and structured
to ensure timely access to urgent/emergent
care for this population group. More specifi-
44
Dialogue Issue 3, 2015
cally, CritiCall should review their process for
accessing specialized beds for surgical care of
obese patients. It may be possible to have a
listing of hospitals that are available for this
population and they should be the first ones
called to help streamline the communications/calls to those more likely to have the
necessary beds and equipment available,” said
the PSRC.
CritiCall had contacted at least four hospitals before finding one that could accommodate the patient.
The PSRC also recommended that the
hospital review its transfer of care policies
and procedures for patients awaiting transfer.
The transfer of care, in this case, had not been
completed between Physician A and Physician B because Physician A had secured the
transfer and assumed that this would take
place shortly after his shift ended. The lack of
transfer of care may have impacted the communication and the understanding of the patient status for Physician B who came on shift
after the transfer had already been secured.
“The patient’s condition, as well as information regarding the urgency, mode and reason
for the transfer should be communicated to the
attending physician if the admitting/transferring physician is not on site. It must be clear at
all times who is the Most Responsible Physician for the patient,” the review stated.
Besides having a history of recurrent leg
cellulitis and chronic constipation, the patient
also visited the hospital often for urinary tract
infections. He was taking lactulose and PEG
3350 and self-administering enemas. His
medical history was remarkable for non-insulin dependent diabetes mellitus, ethanol use,
recreational prescription drug use, tobacco
and marijuana smoking.
After the patient arrived at the emergency
department of Hospital A reporting abdominal pain and vomiting, plain radiographs
(three views of the abdomen) were requested
and films were reviewed by the radiologist. No previous x-rays were found.