As a Texas lawyer who focuses on handling medical malpractice cases for patients, I often have the opportunity to see health care trends and common errors that harm patients.
One of the most dangerous time periods for patient safety, in my experience, is any time that there is a transition in care. This includes things like changing nursing shifts, moving from the intensive care unit to the floor, and discharge from a hospital to a nursing or rehabilitation facility.
The Joint Commission, an organization that accredits hospitals, recognized this type of risk and implemented guidelines requiring policies, procedures, and staff training on hand-off communications between nurses at shift changes. Outgoing nurses must brief replacement nurses about each patient’s condition, medications, and care requirements. Ideally, this hand-off communication should be done in front of the patient and family, so they can participate in the process.
The risky transfer process from a hospital to nursing or rehab facility
When it comes to transferring a patient from a hospital to a lower-acuity facility, like a nursing or rehabilitation facility, there are no binding guidelines or rules, and the procedures are left up to the facilities themselves. Although some hospitals and facilities do a thorough job in the transfer process, in there is a lot of variability and room for disaster.
I recently met with a new client whose transfer experience falls in the disaster category. This person had been diagnosed with lung cancer and went through seven rounds each of chemotherapy and radiation, which successfully destroyed the cancer, except for one spot.
The patient’s surgeon recommended removing the top lobe of the right lung. Considering that we have three lobes in the right lung and two lobes in the left lung, a person can breathe and live fine with one lobe being removed.
After the surgery, the doctor declared the patient cancer free. The plan was to spend two to five days recovering in the hospital, with a return to work the following week.
Before being discharged, though, my client developed pneumonia and the middle lobe of the right lung collapsed. The doctor inserted a chest tube and moved the patient to the intensive care unit (ICU).
The family noticed that infection-control measures were put in place, although no one at the hospital mentioned anything about an infection. Hospital visitors had to wear aprons and gloves while in the patient’s room.
After a few weeks in the ICU, the patient was getting better, but was having difficulty moving the arms and legs. When it came time for discharge from the hospital, the doctor sent her to a rehabilitation facility, to work on the patient’s arm and leg movement.
The only transfer orders that the patient or family knew about was changing the dressing on her surgical incision site every 12 hours. Over two weeks, the patient seemed to get better, but then her progress suddenly stopped. No one at the rehabilitation facility offered any explanation why.
Then one day a family member saw the incision site when a nurse changed the wound dressing. The incision looked swollen and red, and was oozing a greenish liquid. The patient asked the nurse what was wrong and pressed for answers. That led to a wound culture study, which revealed that it was infected with Methicillin resistant Staph. aureus (MRSA), a dangerous superbug.
The next day, the patient called the surgeon and shared the information about the MRSA infection. The surgeon insisted that the patient get to the emergency room (ER) as soon as possible. After arriving at the hospital ER, the surgeon cleaned and debrided (scraped away infected and dead tissue) the incisional wound and kept her in the hospital for two weeks to treat the infection with medications.
In reviewing medical records that our new client brought to our first meeting, we quickly noticed that the transfer records from the hospital where the surgery was performed show that the patient was diagnosed with a MRSA infection two days after the initial surgery. The same transfer records, though, contained no antibiotic prescription to treat the MRSA infection.
The first doctor hospital, who transferred the patient to the rehabilitation facility, never told the patient or family about the diagnosis of the dangerous MRSA infection, let alone the fact that they had not treated it.
Equally disappointing, though, is that the rehabilitation hospital received those records, reflecting a MRSA diagnosis, and accepted the patient with no orders for antibiotics. During the weeks that our client was an inpatient at the rehabilitation facility, no one said a word about the MRSA infection and no doctor wrote an order for much-needed antibiotics.
Two tips for a safe transfer
My client’s story paints a clear picture of a frequent problem. Some doctors and nurses do not share many details about a patient’s care, including that they have developed an infection or other setbacks and how they are being treated.
Transferring between facilities is a notorious time for things to fall through the cracks, but it does not have to be that way. These two tips can help make the process safer for you.
I recommend being an active participant in health care by asking questions, whether you are at a hospital, nursing home, or rehabilitation facility. When you are being given a medication, ask what it is. Better yet, keep a list of your medications and what they are for. If a nurse draws blood for lab work, ask the doctor to explain the results. Do the same thing for radiology studies, like MRI scans, CT scans, and X-rays. You may even want to ask to see the results yourself.
If you are going to be discharged from a hospital to another facility, bear in mind that the hospital will prepare a set of “transfer records.” Transfer records are designed to inform the new facility about key aspects of your diagnosis, condition, treatments, and medications. The transfer records will also typically contain transfer orders, which include prescriptions and medications.
I recommend that you ask for a copy of your transfer records before you are discharged. Then read them to make sure that they are complete and accurate. If not, call your doctor and let the new facility know.
We are here to help
If you or someone you care for has been seriously injured by hospital, nursing, surgical, or physician medical mistakes or negligence, then call the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, for a free consultation about your potential case. Our phone number is 281-580-8800.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas, where he files lawsuits on behalf of patients and their families in medical negligence cases. With years of experience in handling all types of medical malpractice cases, Attorney Robert Painter is able to analyze medical records and other information to uncover medical mistakes, and then aggressively pursue litigation on behalf of his clients.