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.
_________________________________________________________________________________
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 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
