1. Inpatient Handoff Case #4

* 1. Please provide your email address:

Inpatient Handoff Curriculum: Case #4:

Clinical scenario:
Once again, you are the covering night float intern for the week. At 5AM you receive a call from the nurse caring for Mr. John Doe. You quickly go through your stack of handoff sheets and find his information (see link below).

Mr. Doe is a challenging patient. He has been admitted several times to the medical service over the past 2 years for various medical issues. He has known severe 3 vessel CAD and has refused revascularization. He is on amiodarone for prior non-sustained VT (he refused an AICD). He has poorly controlled DM. He is intermittently homeless and he has known history of personality disorder and illicit drug abuse in the past. He is a challenging patient, and has often clashed with nurses and physicians during prior admissions.

The nurse states the patient has been increasingly confused and agitated over the course of the night and now has a temperature of 102. He had been hostile and belligerent to the nursing staff and now is asking for more IV pain medication for his groin and scrotal pain which he states continues to be severe. His 4AM labs have just come back (written at the bottom of the signout).

Signout document for hypothetical John Doe

Signout document for hypothetical John Doe
Reference articles: Consequences of Inadequate Signout (Horowitz et al,2008): click here.

* 2. Regarding this signout... do you have a good sense of the patient’s condition? Is this a good snapshot?

  Excellent Good Fair Poor Very poor
Based the signout--> please rate your ability to "create a mental picture" the patient

* 3. Based on the clinical information provided on the signout form--> what is your initial DDx for his febrile illness?

* 4. Please type a text response of exactly what you would tell the nurse verbally by phone at this time?