A primary care physician referred a case to the hospital medicine patient safety committee for evaluation of excessive testing and medical management involving a patient who had been hospitalized. The patient was a 54-year-old woman with advanced multiple sclerosis who was bed-bound and nonverbal and lived at home with a full-time caregiver. Her mother was her surrogate decision maker and had stated that the patient would not want aggressive medical procedures or cardiopulmonary resuscitation but would want some reversible illnesses treated. The patient was admitted to the medical teaching service at the hospital where she received all of her care after her caregiver noted that she had become increasingly somnolent during the previous day. On presentation, the patient had a fever, tachycardia, leukocytosis (20 × 103/μL), markedly elevated liver function findings, and computed tomography (CT) of the abdomen and pelvis showing cholecystitis. Antibiotic treatment was initiated and the surgery service was consulted.
Zapata JA, Lai AR, Moriates C. Is Excessive Resource Utilization an Adverse Event?. JAMA. 2017;317(8):849-850. doi:10.1001/jama.2017.0698