VTE and a debatable dose

Conclusion

It is commonplace for hospitalists to discuss admission plans of care with our ED colleagues. Rarely, however, do we have such discussions with the same granularity as if we were writing the actual orders ourselves. It is important to remember that if we rely on our ED colleagues (or a house doctor) to fulfill our responsibilities in that regard, we can get trapped by a clinical judgment decision that doesn’t really match what we would have done under the same circumstances. The hospitalist in this case never even saw Mr. SS and he didn’t write the Arixtra order, yet he was deemed culpable for the outcome. Based on deposition testimony, it was readily apparent that the ED physician simply did not know the appropriate Arixtra dosing schedule for a patient weighing more than 100 kg. The jury, however, was ultimately persuaded by the defense arguments and returned a full defense verdict in this case.

Dr. Michota is director of academic affairs in the hospital medicine department at the Cleveland Clinic and medical editor of Hospitalist News. He has relationships with oral anticoagulant makers Janssen, Boehringer Ingelheim, and Daiichi Sankyo.