HospitalInspections.org

Based on interview and record review the facility failed to provide post- surgery radiological services in a timely manner for 1 of 2 patient reviewed for post-surgical radiological services. (#1).


Findings:

Patient #1 was admitted to the facility for a scheduled surgery on 5/18/21. A review of the patient's "Operative report" dated 5/18/21, revealed a robotic assisted hiatal hernia repair was performed on 5/18/21, and the patient was admitted to the Intensive Care Unit (ICU) on mechanical ventilation.

A Pulmonary consult conducted on 5/18/21 at 2:21 PM read, "follow-up esophagram in a.m. ..."
A Critical care note dated 5/19/21 read, " .... No acute events overnight. Planning for bronch (bronchoscopy) today prior to extubation and then esophagram .... Esophagram today after extubation ..."

Extubation is the "Removal of a tube from an organ, structure or orifice. Often associated with removal of the endotracheal tube after ventilation or surgical procedure." (Stedman's Medical Dictionary for the Health Professions And Nursing - Seventh Edition)
"Bronchoscopy is a test to view the airways and diagnose lung disease." (retrieved from medlineplus.gov 7/16/2021)
"Esophagram: A series of x-ray images of the esophagus" (retrieved from medicinenet.com 7/16/2021)

The radiology "Order Note" dated 5/19/21 at 7:35 AM read, "still intubated. Nurse will call when ready."

A review of the patient's clinical records revealed a "Timed Event" note documented by Registered Nurse (RN) A on 5/19/21 at 4:00 PM indicating patient #1's family member "expressed frustration" regarding her mother's care "(patient unable to have esophagram and pm shift care)"

Timed event note by RN A dated 5/19/21 at 4:30 PM read, "did not receive a call from x-ray. Have not been able to get a hold of X-ray. Once able to contact them, were told the radiologist left at 1400 (2 PM) today. Esophagram to be completed in the morning."

On 7/08/21 at 9:45 AM, RN A stated patient #1's surgeon's protocol status post-surgery included a bronchoscopy prior to extubation, then an esophagram as soon as possible after extubation. RN A said the bronchoscopy was performed with no issues, the patient was extubated, but she had "issues" with getting through to x ray for the esophagram. RN A stated she called the Radiology department "multiple" times and was finally told that the Radiologist had left for the day and the procedure would be done the following day. RN A stated she notified the surgical Physician Assistant, and the Intensivist, who were frustrated at the situation. RN A said the patient's daughter had concerns about the procedure not being done.

On 7/08/21 at 9:59 AM, the ICU- Nurse manager (NM) stated patient #1 was admitted to ICU on mechanical ventilation. Prior to being weaned from the vent, a bedside bronchoscopy would be performed. After the sedation wears off, an esophagram would be done. The NM stated radiology was notified about the esophagram, but when the nurse "got hold" of radiology, she was told the radiologist had left for the day.

On 7/08/21 at 10:14 AM, the Imaging Director stated inpatient physician orders for radiology would be placed in the electronic records and would populate on the radiology worklist. She stated Post op upper GI studies could not be performed until the patient was no longer intubated and was able to stand for the exam. The imaging Director stated review of documentation showed that in the AM on 5/19/21, an x-ray tech reached out to the nurse, the patient was still intubated at that time, and communication indicated the nurse would call when the patient was no longer intubated and was ready to come down for imaging. She said the comment area within the electronic system on 5/19/21, showed the Tech placed a call at 2:19 PM, and by the time radiology coordinated with the nurse, the Radiologist had left for the day. The Imaging Director stated she was not involved on 5/19/21, and she was made aware of the concern on 7/07/21.

Review of the patient's physician orders showed an "upper GI (gastrointestinal) Postop Gastrografin (esophagram) s/p (status/post) Robotic Laparoscopic Surgery ...reconstruction of diaphragm hiatal hernia repair," to rule out leak was ordered on 5/18/21 at 1:19 PM. Patient #1 was extubated on 5/19/20, but the esophagram status post her extubation was not completed until 5/20/21, due to the unavailability of the Radiologist.