Future Leaders Communiqué Volume 3 Issue 4 October 2018
Download PDF: FL Communiqué October 2018
- Guest Editorial
- Case: A missed opportunity
- Could this be sepsis? An important question
- Communication in medical teams
- Comments from our peers
Welcome to the October 2018 issue of the Future Leaders Communiqué. In this issue, we will be exploring how difficulties in recognising and communicating abnormal results from laboratory and imaging investigations leads to significant patient harm. We will be reflecting on the coronial inquest into the death of a 65-year-old man who was admitted to a regional hospital after a quad bike crash and subsequently died of sepsis.
In our role as junior doctors, we are responsible for the investigations we order and for ensuring the results are reviewed and acted on as required. During a busy day of ward rounds, admissions, and Medical Emergency Team (MET) calls, it is often difficult to find the time to sit down and carefully review the results of all the investigations we have ordered. When we do find the time to review a result, it is sometimes challenging to know how to interpret an abnormal result and what action is required.
Reflecting on my internship and residency years, I recall a number of times when I had discovered abnormal test results and needed to rely on my registrars to interpret their significance. For example, what do I do with a patient who has an elevated troponin in the setting of new onset atrial fibrillation?
As junior doctors, we are at the start of a lifetime of learning and as such, are not expected to know all the answers. However, we should always aim to do the best by our patients. This includes seeking help from our senior colleagues and supervisors if we are unsure of how to manage a patient, interpret a test result, or are generally concerned about a patient’s progress. Working in, and contributing to, an environment that fosters a supportive culture with adequate supervision empowers junior doctors to seek help when required and leads to improved outcomes for our patients.
As we all know, medical teams in hospitals are led by a consultant who has completed their specialty training. They are responsible for the supervision of junior doctors and are ultimately accountable for the patient’s care. Junior doctors may work in these teams as interns, residents or registrars. Registrars are generally responsible for the day-to-day management of patients, which includes making sure that patients are reviewed daily, investigations are ordered, and appropriate management is provided. Registrars are often supervised at a distance by consultants who conduct their ward rounds on patients with variable frequency (daily to weekly) and who are available via phone.
Junior doctors, especially registrars, are thus the eyes and ears on the ground for consultants and are of great importance in the quality of patient care. To help ensure safe patient care, junior doctors should report to the consultant any significant investigation results or changes to a patient’s progress. As a junior doctor, there is a natural desire to impress the consultant – who may even be your speciality training supervisor – and create the impression that everything is running smoothly. However, we cannot let this desire or the fear of appearing less than perfect compromise patient care.
As discussed in the coronial inquest in this issue, a failure to communicate an abnormal result to the ward consultant led to a missed opportunity to recognise and treat developing sepsis. Speaking up about abnormal investigation results may take a little extra time, but will ensure the appropriate action is taken for the patient.
Sepsis is one of the leading causes of hospital deaths worldwide. When patients are developing sepsis, it can be difficult to identify, and may present in an atypical fashion. Timely recognition and appropriate management of patients at risk of sepsis is important in reducing mortality associated with this condition. As junior doctors, we play a crucial frontline role in thinking about the possibility of sepsis. We can then identify early features and initiate prompt treatment to ensure that sepsis is never missed in our patients.