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Patient and clinician Narratives

Vignette of HANDOVER situation

An 80 years old woman calls her Primary Care Provider (PCP) Call service at 5 am complaining of abdominal pain. She thinks the pain is due to a urinary tract infection, for which her PCP prescribed antibiotics the prior day. She asks the triage nurse for something to alleviate the pain. The triage nurse asks the patient about her general condition and if she had symptoms before. The patient said she never had these symptoms before. The triage nurse advised the patient to take paracetamol first and asked the patient to call back if that did not help within 1 hour. The next morning the patient was found dead in her bathroom, with a small amount of rectal blood loss. It appeared that this patient suffered an acute abdominal aneurysm dissection, diagnosed 10 months earlier. The surgeon and the patient decided not to operate because the operation would be very risky. This diagnosis was communicated with the patients PCP. Hand off of this diagnosis to the PCP Call Service was not considered nor was it discussed with the patient and her family.

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