Failure to Ensure Timely Cardiology Consult and Continuity of Anticoagulation Therapy
Penalty
Summary
A deficiency occurred when the attending physician failed to follow up on hospital discharge recommendations and her own notes regarding a necessary cardiology consult for a resident with significant cardiac conditions, including a left ventricular thrombus, low ejection fraction, prior stroke, ischemic cardiomyopathy, and coronary artery disease. The resident was discharged from the hospital with instructions to follow up with a cardiologist within three months and to continue anticoagulation therapy for at least three months. However, the medical record review revealed that the resident's anticoagulant was discontinued for approximately one month within two months of admission, and there was no documented evidence of a cardiology consult being ordered or completed during this period. During interviews, the attending physician acknowledged awareness of the need for a cardiology consult and the importance of continued anticoagulation but deferred responsibility to the facility for arranging the consult. She also could not confirm whether the resident had seen a cardiologist and admitted that any order for a consult may have been given verbally, with no documentation found in the chart. The Director of Nursing was also made aware of the attending physician's lack of follow-through on the resident's care plan, specifically regarding the cardiology consult and monitoring of the resident's cardiac condition.