A 46-year-old woman is hospitalized due to severe depression and fatigue. She has no other medical problems. Routine laboratory tests are ordered and the patient is started on antidepressant medication. After a week, her depression improves slightly and she is discharged home to continue with outpatient care. However, the patient remains severely fatigued and is unable to return to her job, forcing her to take a leave of absence. At her follow-up appointment 2 weeks later, review of the hospital record by the outpatient physician reveals a TSH level of 15.2 µU/mL that was never addressed by the inpatient physician. Subsequent evaluation and treatment with thyroid hormone result in rapid improvement of her depression and fatigue. Which of the following is the appropriate categorization for this type of medical error?

Question

A 46-year-old woman is hospitalized due to severe depression and fatigue.  She has no other medical problems.  Routine laboratory tests are ordered and the patient is started on antidepressant medication.  After a week, her depression improves slightly and she is discharged home to continue with outpatient care.  However, the patient remains severely fatigued and is unable to return to her job, forcing her to take a leave of absence.  At her follow-up appointment 2 weeks later, review of the hospital record by the outpatient physician reveals a TSH level of 15.2 µU/mL that was never addressed by the inpatient physician.  Subsequent evaluation and treatment with thyroid hormone result in rapid improvement of her depression and fatigue.  Which of the following is the appropriate categorization for this type of medical error?

Quizplus · Accepted Answer

Hypothyroidism is a known cause of depression and is routinely screened for with a TSH level. This patient's elevated level (normal: 0.5-5.0 µU/mL) should have been detected during hospitalization and prompted further workup. The inpatient physician's failure to note and address the abnormality is a preventable medical error that resulted in delayed diagnosis. Preventable medical errors involve harm to the patient by an act of commission or omission rather than from the underlying disease and are the result of failure to follow evidence-based best practice guidelines. (Choice A) Malpractice is a legal determination; it involves situations in which the treatment provided is below the accepted standard of practice and has resulted in injury or death to the patient. It is not a category of medical error but rather refers to the consequence of many different types of errors that result in harm. (Choice B) A near miss is a medical error that is recognized before any harm is done to the patient (eg, a patient is prescribed a lethal dose of medication, but the error is caught by the pharmacist). In contrast, the patient in this case has been harmed by the delay in appropriate diagnosis and treatment. (Choice C) This error would have been prevented if the physician had adhered to the standard of care. A non-preventable adverse event is a complication that cannot be prevented given the current state of medical knowledge (eg, an allergic reaction to a medication in a patient with no known history of drug allergies). (Choice E) A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury (eg, inpatient suicide, death of a full-term infant, retained object after surgery) that requires immediate investigation. Educational objective: A preventable adverse event is defined as injury to a patient due to failure to follow evidence-based best practice guidelines. __________ References: Reducing medical errors and adverse events. (http://www.ncbi.nlm.nih.gov/pubmed/22053736)

A 46-Year-Old Woman Is Hospitalized Due to Severe Depression and Fatigue