As a former hospitalist, this is a bread and butter case and this outcome is embarrassing. I would absolutely settle. Did no one review the abdominal xray?? NPO, ngt for decompression, IV Fluids, general surgery consult, small bowel series/follow-through in a couple days. Thank you and good night.
I think $6.5M is far too much for a frail 77yo who already had 2 hip replacements. They are unlikely to live 5-10yrs, no loss of earnings. I am curious what the financial pros think? However post-op ileus/obstruction was considered, there to be diagnosed and still missed. I would consider that the very definition of negligence. Had she been diagnosed and treated she may still have had complications and may have died for another reason. Regardless she would be in a rehab/SNF and not go back to her prior baseline
As a bedside nurse I'm not surprised that bowel movement size was an issue in a case, and I was hoping you'd talk about it more lol. It's so subjective and a lot of times when I'm documenting I go back and forth.... was that "medium" or "large"? Was it a "small" BM or was it a "smear"? I don't recall ever getting formal guidance on this, either in my education or during job training. By contrast, we did learn how to judge other subjective things like urine color, how to quantify %s of meals eaten, etc.
I'm also interested in others' thoughts on the family saying the patient's BM was so small it didn't count vs the nurse documenting a large BM. I can easily picture, for example, the pt having a small BM, the family leaves the room bc they don't want to be there, and then the pt poops a lot more when she's turned for cleaning. But I can also easily imagine an inexperienced nurse giving an enema, seeing a lot of fluid come out and documenting bowel movement when it was really just the enema coming back out.
Some thought-provoking communication issues here too, like the nurse documenting the doctor wanted the pt NPO, but no one ever putting in the order (for days?).
Do you think the nephrology fellow/attending should have been named? An alarming finding was documented, but did they make any effort to address it, even if it wasn't related to the kidneys? Also, from an EM perspective, I would definitely order a CT abdomen if the X ray shows an abnormality. Actually who am I kidding I would've just started with the CT. The point about failing to put in an NG tube though I don't totally agree with because the evidence for those is questionable, but yes she should've been NPO.
What was footnote 1 in the ortho's opinion?