1. Inpatient Handoff Case #5

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Case notes: click here. Reference article: Lost in Translation (Solet et al,2005): click here.
Inpatient Handoff Curriculum: Case #5

This case is a little more complicated. Please expect to take 10 min to read thru this scenario...

You are seeing a 25 year-old patient as an acute care appointment in the general medicine clinic. It's 13 days after a hospitalization where she was diagnosed with new arm swelling from bilateral upper extremity DVT's complicated by bilateral pulmonary emboli. She had been healthy prior to 13 days ago. This is all new.

She is here today because she was having continued arm pain.
You go to the electronic medical record to get more details and review the past 2 weeks events. You see that multiple handoff's have occurred during her care.
Handoff's involved in this case:
• ED physician --> to the night float resident at 2am
• Night float resident --> to the general medicine resident at 7am
• Ward resident--> to the managing subintern and ward attending at 830am during rounds
• Medical subintern --> to night float intern for x-cover from 7pm to 7am
• Nigh float intern --> back to the medical subintern at 7am
• Inpatient medical team --> discharge handoff to new outpatient primary care provider
• Outpatient PCP --> to covering colleague (PCP is out-of-the-office, you are covering acute visits today)
Click on the link above (called "case notes") and read the hospital course from the EMR, as well as the recent clinic note. Read carefully and try to see if you see any potential areas of concern regarding the various handoffs.
Inpatient notes, discharge instructions and clinic follow-up notes for Sara Smith