Deficient assessment: Study finds more than 80% of sepsis-related complaints against a doctor were the result of incorrect or delayed diagnosis

Deficient assessments are to blame for the large majority of sepsis cases that were either diagnosed incorrectly or not diagnosed right away, leading to a complaint against a Canadian physician. Of 163 cases analyzed in a peer-reviewed study by the Canadian Medical Protective Association (CMPA), 81% involved a failure by a physician to consider sepsis or reassess the patient prior to discharge. The findings suggested “problems with information-gathering or considering diagnoses,” wrote the study authors. “For example, some physicians failed to reassess symptomatic high-risk patients before discharging from emergency departments. Also common were physicians failing to perform tests or interventions (e.g., bloodwork) or inadequately monitoring patients.” Other factors identified in the cases included physicians not assessing a patient in a timely manner after handover or consultation, and poor coordination of care that led to delays in diagnostic testing. “Sepsis is a difficult diagnosis to make, so awareness of its possibility is probably one of the most important things for physicians,” said Dr. Gary Gerber, director, safe medical research at the CMPA and senior author of the study. “If you don’t think about it, you’re not going to make the diagnosis but hopefully with awareness we’ll be able to move the diagnostic wheel forward.” Read: Suspect unlawful activity with prescriptions or medications? Here’s how to respond, CMPA says In almost half of the cases, the patient had died, with the highest mortality rate occurring amongst older patients: 65% for patients between 65 to 79 years old, and 89% for patients 80 and older. Severe harm such as limb amputation due to gangrene, or brain damage was experienced by 30% of patients, while fever was documented in 26%. About 25% had recently undergone surgery and almost 40% were in an intensive care unit. Almost half of patients made multiple visits to a family physician, walk-in clinic or emergency department before they were finally diagnosed with sepsis. Of this group, 75% made more than one visit within 72 hours of their sepsis being recognized. While there is no single, straightforward solution that can prevent delays in diagnosing sepsis, doctors can be alert to certain signs of possible sepsis, said Dr. Garber. “For example, in post-operative cases where a patient is complaining of abdominal pain, even if this is expected, look for other signs like fever,” he said. “Perhaps this is an early sign that one should be doing more investigations.” Sometimes a patient comes in with fever and low blood pressure and is given Tylenol and fluids. Instead of sending these patient home once they’ve been stabilized, it might be advisable to keep them for further evaluation to make sure the improvement isn’t temporary. Read: ChatGPT, unnecessary paperwork and Canadian physicians Doctors can also educate their patients about what to watch for after they’ve been sent home. “Instead of just telling them to come back if they get worse, be more specific about what they should be looking out for,” said Dr. Garber. “For example, if they’re complaining of a bad cold or sore throat, you might tell them they could develop a fever but if the fever gets worse, these are the kinds of things you want to do.” Each case in the study—published Feb. 13 in Critical Care Explorations— represents a complaint against a physician in a civil legal suit, a regulatory college procedure or a hospital investigation. All cases were closed by the CMPA between Jan. 1, 2011 and Dec. 31, 2020. A total of 218 physicians were involved in these cases, 29% of whom specialized in family medicine or general practice, 27% in emergency medicine and 22% in surgical. Perinatal infections, neonatal infections, and puerperal sepsis were not included in the study while other infections such as endocarditis, clostridioides difficile, staphylococcus aureus, pneumonia were included as they may progress to sepsis. Most of the clinical encounters happened in large urban centres. Read: Avoiding pitfalls in the ED: Recognizing and managing risks of diagnostic error

Deficient assessment: Study finds more than 80% of sepsis-related complaints against a doctor were the result of incorrect or delayed diagnosis

Register for free access or login.

Related Topics