Initial Case Details Sofia Rossi

Sofia Rossi is a 59 year old homemaker.

One Tuesday morning at 0500 she awakes from sleep with lower abdominal cramping that she did not have when she went to bed the previous night. She takes some Tylenol and tries to return to sleep but by 0630 when her husband awakes the pain is more severe. She is brought to a walkin medical centre by her son. The physician at the walkin clinic examines her and a clinical diagnosis of diverticulitis is made. The physician also orders a CBC, creatinine and electrolytes and provides Mrs. Rossi with a prescription for a 7 day course of oral ciprofloxacin and metronidazole. Mrs. Rossi gets her blood work drawn and fills her prescription.

Over the evening and the next day Mrs. Rossi is uncomfortable, in pain and running a fever off and on, she is taking Tylenol which seems to make her feel better for short periods.

By Thursday morning, Sofia is in quite a lot of pain and she returns to the walkin clinic. She is seen by a different physician at 0840 who reviews the notes and results of her blood work from the previous visit. The physician notices that Sofia has an elevated temperature, is tachycardic (120/BPM), tachypneic (24/min) and slightly hypotensive (94/63 mmHg) and he is concerned that she may be developing sepsis. He advises Mrs. Rossi to go to the ED and because of her hypotension, calls EMS to transport her directly to the hospital. Mrs. Rossi arrives at the ED at 0930. In the ED, Mrs. Rossi is seen and a surgical consult is ordered. She has several lab and diagnostic tests and early that evening at 17:10 she is taken to the OR. The surgeons perform a left hemicolectomy and colostomy and Mrs. Rossi is sent to ICU postop as she had persistent low blood pressure and high oxygen requirements. She is intubated and sedated.

Mrs. Rossi's urine output is minimal on Friday, so she has a central line inserted and is started on dialysis. Mrs. Rossi is extremely ill and her prognosis is considered quite guarded.

The family is upset with the length of time it took for Mrs. Rossi to get from the ED into surgery, and the lack of communication with various members of the healthcare team.