I read with fascination and some horror the story of Rory Staunton, a 12-year-old New York youth who died this spring of sepsis after cutting open his arm while diving for a basketball in his school’s gym. Actually, the story of what happened to Rory is quite complicated, and it’s best to read the entire account of it in the July 12 edition of The New York Times, as reported by Jim Dwyer, a Times reporter who was also a friend of Rory’s family.
Of course, on a human level, this story is a personal and family tragedy involving a promising young life cut off so terribly, terribly early. But it is also a very complex patient care delivery story, one with very strong elements around physician-to-physician communication, care transition, clinical decision support, and electronic health record (EHR) elements to it. There are so many questions that need to be answered, and Dwyer’s very detailed and well-researched report obviously struck a chord with a lot of people, including clinical professionals, with more than 1,600 comments posted after the article was published, many of them from emergency department (ED) physicians and others who have faced the types of clinical circumstances presented by Rory Staunton’s case, in their own work.
It’s important to read the entire article before beginning to come to any conclusions; and even then, of course, any reader reading the article will be doing so long after the events and developments in the case have already played out. But what seems inescapable to me are the missed connections all the way along, some of them relating to how physicians communicate with each other (and all too often, don’t communicate with each other) in our healthcare system, how clinicians are alerted (or, in this situation, not alerted) to urgent and emergent developments in patient cases, and how the patient record is used (or isn’t used) to build a broader understanding of an individual patient’s situation. At various points in the Rory Staunton saga, things could have turned out quite differently; and the missed connections that turned out to be fatal for Rory might have been connections made instead.
In particular, the interoperability and immediacy of availability of urgent lab results and of physician notes across the inpatient-outpatient divide, struck me as major issues in the Staunton situation. Consider this excerpt from the Times article: “Moments after an emergency room doctor ordered Rory’s discharge, believing fluids had made him better, his vital signs, recorded while still at the hospital, suggested that he could be seriously ill. Even more pointed signals emerged three hours later, when the Stauntons were at home: the hospital’s laboratory reported that Rory was producing vast quantities of cells that combat bacterial infection, a warning that sepsis could be on the horizon.” But, tragically, the article goes on to note, “The Stauntons knew nothing of his weak vital signs or abnormal lab results. ‘Nobody said anything that night,’ Ms. Staunton [Orlaith Staunton, Rory’s mother] said. ‘None of you followed up the next day on that kid, and he’s at home, dying on the couch?’”
And regardless of where the ultimate blame lands (and of course, there’s a good chance Rory’s parents will sue the hospital involved), Rory Staunton’s case highlights the need for very powerful, very useful clinical information systems that will provide clinicians with everything they need to know at the point of care, and that, importantly, will help bridge the inevitable gaps between and among the physician office, the outpatient clinic, the emergency department, and the inpatient hospital, and that will make it easy for clinicians to use clinical decision support tools and alert systems and hard for them to ignore them.
Of course, clinical information systems are only part of the equation, and sound medical judgment and other factors will always be elements present in whatever the outcomes of cases such as Rory Staunton’s might be. But excellent clinical information systems, well-implemented and intelligently used, will be important tools in overcoming the care transition and communication gaps that so often plague well-meaning, skilled clinicians in our healthcare system.