Delayed Diagnostic Imaging and Result Follow-Up After Fall
Penalty
Summary
The facility failed to promptly schedule and obtain results for a physician-ordered MRI of a resident's right hip following a witnessed fall during an assisted shower. The resident, who had severe cognitive impairment and multiple comorbidities including dementia, hemiplegia, and was on blood thinners, experienced a fall and was initially sent to the emergency department (ED) for evaluation. The ED performed CT scans of the head and spine, but no imaging of the right hip was conducted at that time. Upon return to the facility, the resident began to complain of right hip and shoulder pain, refused to get out of bed due to pain, and required increased administration of narcotic pain medication. Subsequent evaluation at the ED included X-rays of the right hip and shoulder, which were reported as showing no acute fracture or dislocation, but the hip X-ray was noted to be improperly positioned, potentially limiting diagnostic accuracy. Despite ongoing severe pain and a recommendation to consider a non-contrasted CT scan if symptoms persisted, there was no documentation that further imaging was pursued until the resident's family requested an MRI nearly two weeks later. The MRI was ordered and scheduled eleven days after the order, and when finally performed, revealed an acute, impacted subcapital hip fracture with lateral displacement and extensive soft tissue edema. There was an additional delay in obtaining and acting upon the MRI results, with the facility not receiving the finalized report until approximately 36 hours after the MRI was completed. The resident was then transferred to the hospital for surgical intervention. Throughout this period, the resident experienced continued severe pain and immobility, as evidenced by increased use of narcotic pain medication and family observations of the resident's inability to move her leg. The delay in both scheduling the MRI and obtaining the results directly contributed to the delay in diagnosis and surgical repair of the hip fracture.