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Communication vital when transferring care of a patient
An article for physicians by physicians
Originally published December 2005 / Revised May 2008
IL0540-1-E

Of interest to all physicians transferring or receiving patients

A 38-year-old male was admitted to the emergency department with a significant upper gastrointestinal bleed. A peptic ulcer was suspected and the patient was referred to Dr. A, the surgeon on call.

Dr. A performed a gastroscopy, but was unable to find a definite source of the hemorrhage. He contacted Dr. B, a surgeon at a nearby tertiary care hospital, for advice. Dr. B suggested the patient had a lesion in the bulb of the duodenum that would bleed intermittently and advised a surgical procedure.

Dr. A performed a pyloromyotomy and a gastrotomy, but was still unable to make a positive diagnosis. The patient's condition deteriorated and Dr. A transferred him to the tertiary care hospital, where Dr. B performed a gastroscopy and made a preliminary diagnosis of a Dieulafoy-type lesion, a rare condition. Dr. B was off call for the weekend, and the care of the patient was transferred to Dr. C, a senior surgeon on-call. However, Dr. B did not inform Dr. C of the diagnosis or his treatment plan. Over the weekend, the patient again began vomiting blood, and his condition suddenly deteriorated. Dr. C ordered a Gastrografin study to investigate for a possible leakage/perforation, but not a second gastroscopy as Dr. B's treatment plan had indicated. Unfortunately the patient suffered a cardiac arrest while in the x-ray suite and could not be resuscitated.

The legal outcomes

• The family commenced a legal action against many physicians, including the three surgeons (Doctors A, B and C).
• Dr. C was dismissed from the action prior to trial.
• At the trial, the action against Dr. A was dismissed; however, the court found against Dr. B and the family was awarded compensation, which was paid by the CMPA on behalf of Dr. B.

In his decision the judge noted that, given the diagnosis, the high risk to the patient and the nature of the treatment plan, careful monitoring of the patient and appropriate intervention was likely to be required. It was therefore incumbent on Dr. B to take all reasonable steps necessary to ensure the patient's history was communicated to Dr. C and the treatment plan was followed.

In his reasons, the judge stated that by these omissions, Dr. B had not met the reasonable standard of care of a prudent physician. Moreover, he stated Dr. B owed the patient a duty to ensure he would be safe during Dr. B's absence and failure to do so was not only an omission but also a failure to discharge a fundamental duty of care to his patient.

Take appropriate steps when transferring care

This case emphasizes the importance of communication when transferring care to another physician.

Consider:

• Have you thoroughly explained your patient's condition (including any rare diagnosis) and anticipated treatment plan to the physician to whom you are transferring care?
• Are you satisfied the physician to whom you are transferring care of the patient has the required expertise to manage the patient's condition?