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Based on interview and record review the physican failed to recheck the elevated white blood cell count of the patient before discharging the patient to home.

Findings:

On 07/24/2014 @ 0229 the patient was brought to the Emergency Room with complaints of waking up @ 0100 with confusion and short term memory loss, abdominal pain and diarrhea. The stroke protocol was initiated and followed. The patient was admitted to the hospital for 24 hour observation. The patient had an initial white blood cell count of 9.6 @ 0245 on 7/24/14. The patient had lab work redrawn @ 0920 and the white blood cell count had risen to 17.4 (4.0-10.0 normal range). There was no order for repeat lab work to further evaluate the white blood cell count.

The patient was discharged from the hospital on 07/25/2014 @ 1728 with a diagnosis of Transient Global Amnesia. The Physician who discharged the patient wrote the discharge note on 07/25/2014 @ 1625 and included the white blood cell count from 07/24/2014 @ 0245. The physician did not document in the medical record that the abnormal lab value had been assessed. The patient did not have any discharge instructions or follow up blood work in relation to her abnormal white blood cell count. The patient was readmittted to the hospital on 07/31/2014.

The patient's chart was sent out to IPRO for review from a physician Board certified in Internal Medicine. The physician opined that eh standard of care was not met. The rapid rise of the white blood cell count on the morning labs should have been evaluated prior to discharge. At least the CBC needed to be rechecked and if it remained elevated to possibly start a septic workup. If a white blood cell count was still markedly elevated, then further hospitalization to evaluate this was warrented.

An interview was conducted with the physician on 03/27/2015 @ 1040. The physician stated that patients were sent home all the time with abnormal lab values and they were given scripts to follow up with lab work on an outpatient basis. The physician stated that the lab value could have been an error, but did not recheck the test. The physician stated he did not see the test results and they may not have been in the computer but he could not justify changing the patient from an observation to a full admission because of a lab value when she had no other symptoms. The patient was anxious to leave and get back on a plane to North Carolina. The patient was not given a script for follow up lab work because she lived in North Carolina.