All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor ----------------------------------------------------------- NOTE: You can make the print bigger with the font button on your browser! (It's usually a big "A") ----------------------------------------------------------- Catheterization Patient Dies Because All Operating Rooms in Use From The Journal of Clinical Engineering http://journals.lrpub.com/jce/cases/case_12.htm When patients have a cardiac cath, hospitals should be prepared to handle emergencies, including reserving an operating room. In addition, consent forms signed by patients before a procedure should disclose the full nature of the procedure, including the possibility of death. Incident Report A male patient admitted to St. Dominic-Jackson Memorial Hospital in Jackson, Mississippi for a cath procedure was asked to sign a consent form to affirm that he understood the nature of the procedure. The form included a statement that the patient was aware that the cardiac cath lab was "equipped and personnel assisting the doctors are trained to handle emergencies that may arise in order to make the test as safe as possible." During the procedure, the physician found a lesion on the patient's left coronary artery. The patient began experiencing chest pains shortly after the procedure and ultimately went into cardiac arrest. Because both operating rooms at the hospital were in use, emergency bypass could not be performed there. It was later confirmed that the physician was unaware that the operating rooms were in use when he started the catheterization. Inquiries were made to other hospitals in the area to see if operating rooms were available. The patient's condition worsened and he died in the cath lab. The man's widow brought a wrongful death action against the hospital. Discussion The question of whether a hospital should ensure availability of emergency support facilities during cath has been considered by healthcare professionals as well as lawmakers. An estimated 2 patients in 1,000 die during diagnostic cardiac caths, while 5 patients experience other complications, including stroke and heart attacks. At the time of the incident, the hospital policy did not require an operating room to be reserved for patients having routine cardiac cath. The lawsuit alleged that the hospital failed to provide necessary emergency support facilities and failed to fully disclose the nature of the procedure before obtaining consent. The issues centered on whether the hospital failed to exercise reasonable care in performing the cath and on the facts surrounding certain representations made in the consent form signed by the patient. Testimony from several hospital employees indicated that the hospital was aware of the life- threatening nature of caths. Despite the fact that several patients had died during cath procedures, the hospital continued to operate under old policies regarding emergency support and obtaining consent. The court pointed out that it is therefore possible to conclude that the hospital failed to exercise reasonable care. The state supreme court argued that the hospital had a duty to show why no operating room was kept available during such potentially dangerous procedures. It also found that the consent form failed to mention that death was a possible outcome of the procedure. A policy to reserve an operating room while a patient is undergoing cardiac cath is warranted because complications can arise from a procedure known to be life- threatening. In addition, if a room reservation policy exists and a new emergency patient needs surgery, caths should be post- poned until emergency support facilities are available. Although having an operating room reservation policy will not guarantee that a new emergency patient will not need the facility while a cath is in process, the danger can be minimized. A hospital opens itself to claims based on failure to disclose potential risks if consent forms do not clearly identify worst-case scenarios. Patients who do not get all of the facts about risks involved in a procedure are not considered to be properly informed. As uncomfortable as it is to hear what the risks are, patients and their families need all the available information to make a rational decision about their treatment. Risk, Safety and Training Issues The key risk management issue here is the importance of recognizing the potential dangers posed by a given procedure and properly informing the patient of them. In the case of cardiac caths, it is dangerous not to keep an operating room available to deal with complications. Facilities often base policies and procedures on their previous experience. In this case, however, the hospital continued to operate under a previous policy despite the fact that several patients had died during caths. It is also important to establish policies and procedures to ensure that emergency facilities are available before potentially life- threatening, procedures are started. Communication links should be established to make clear that a particular operating room is being reserved while a procedure is taking place in another part of the hospital. A second, equally important risk management issue is the information included on consent forms. Disclosure or consent forms should clearly identify risks, including the possibility of death. Summary of Risk Management Issues By not reserving operating rooms for patients having treatments that could possibly result in life threatening complications, a hospital increases the risk of patient deaths. Disclosure or informed consent documents that leave out information on the worst-case outcome of a particular procedure are a source of exposure for a hospital.