The Case For Quality – Second Edition

In an effort to improve quality, transparency and safety, the Health Authority Medical Quality Committee is sharing real stories about events that all medical staff can learn from. These anonymized stories summarize unique events that can jeopardize quality and highlight what medical staff can do to prevent them from recurring. Island Health is dedicated to providing care at the highest levels of quality and safety and everyone has a role. Similar to the case examples in the Canadian Medical Protective Association’s Perspective publication, these stories help remind all medical staff how we can provide better care.

A patient presented to an Island Health hospital with fever and rigors one day after an ultrasound guided prostate biopsy. The patient was started on intravenous antibiotics and the sepsis protocol was followed. After initially improving, the patient’s condition deteriorated. While the patient’s transfer to a higher level of care had been initiated, the patient rapidly decompensated and passed away prior to transfer being completed.

While procedure-related sepsis is rare, it is critical that it is identified and treated early. This case also highlights various important reminders:

  1. Patients who present with fever following a procedure should be:
    1. Aggressively worked up for sepsis; and
    2. Empirically treated with antibiotics of a differing class than the prophylactic antibiotic administered for the procedure. Learn more at the BC Sepsis Network.
  2. Lactate clearance is usually associated with decreased mortality. However, lactate normalization can occur with a patient who is deteriorating. Always rely on the clinical picture and not a laboratory value. The ten pitfalls of lactate clearance in sepsis is a great resource.
  3. The opinion of the sending physician to transfer the patient to a higher level of care takes precedence when a patient requires a level of care that cannot be provided at the current site; whether for treatment modalities, urgent diagnostic tests, or multidisciplinary expertise. Call the patient transfer network 1-866-223-2337 and view the HLOC protocol.
  4. Transrectal ultrasound-guided prostatic biopsy carries a small risk of urinary tract infection, bacteremia and sepsis. Patients who decompensate despite appropriate urosepsis treatment should be considered for further imaging to rule out prostatic abscess. Learn more in the article Prevention of sepsis prior to prostate biopsy.

Links to publications are provided as examples and do not represent an extensive literature review.