Johnston Medical Center ER Vignette Survey – January 29-30, 2018

On January 29-30, 2018, I performed a brief survey of the medical staff, nursing staff, and other ancillary staff during the night shift in the ED.  Each staff member was given the survey document below, and asked to consider the vignette below for a minute or so and then to write what they thought the most likely problem(s) could be.    With the exception of answering a question about ability to ambulate, (the patient could ambulate) No additional information was provided about the patient.

A total of 31 personnel were surveyed.

Surveys were provided to staff, who were asked not to discuss their responses with other  personnel. On returning the surveys,  the participants, in addition to their answers, indicated only their credential  (MD, PA, RN, etc.)   The purpose of the survey was not disclosed to participants.

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Patient is a 24-year-old female who presents to an urgent care facility for evaluation of right lower extremity pain.  8 days previously the patient had been struck on the right medial calf by a pallet full of heavy photographic equipment.   Patient has pain and swelling to the leg with worsening since onset.

Past history:  No significant medical issues

Medications: NuvaRing contraception

Vital signs: Assume normal

Exam:  Extensive bruising and tenderness to the right medial calf and pain to the ankle

Survey Question:  What is your prime concern(s) in this patient?         

Survey Responses from thirty (30) licensed / certified personnel surveyed, were as follows, listed by each discipline: 

MD (ER) – DVTs

MD (ER) – DVT

MD (IM) – DVT

MD (ER) – DVT, Compartment syndrome

PA-C  (ER) – DVT

PA-C (ER) – DVT, Compartment syndrome

PA-C (IM) – DVT

PA-C (ER) – DVT

PA Student – DVT, Compartment syndrome

FNP (IM) - DVT, Compartment Syndrome, Hematoma, Vascular compromise

RN – DVT

RN – DVT, fracture

RN – DVT

RN – Compartment syndrome

RN – DVT

RN – DVT

RN – DVT

RN – DVT

RN – DVT

RN – DVT

RN – DVT

RN – DVT, Foreign body (if open wound)

RN – DVT

RN – DVT

RN – DVT, fracture

RN – DVT

LPN – DVT, fracture

RCP – DVT, Compartment syndrome,  Necrotizing fasciitis

RCP – DVT, fracture

EMT-Intermediate – DVT

EMT-Paramedic – DVT

Results:

96.8%    (30/31)                  Recognized risk for DVT               

19.4%    (6/31)                    Recognized risk for Compartment syndrome 

12.9%    (4/31)                    Recognized risk of Fracture

9.7 %     (3/31)                    Recognized risk for other conditions (Hematoma, Infection, Vascular) 

DVT Risk Identified by provider groups:

100%      Medicine Group:             MD, PA-C, PA-S, Personnel

 94%       Nursing Group:               FNP, RN, LPN Personnel

100%      Ancillary Personnel:       RCP, EMT Personnel