Confusion after midnight

Conclusion

This case incorporates several important issues previously addressed in this column over the past year. First, hospitalists need to appreciate the significance of anticoagulation and be well versed on how to correct excessive anticoagulation with or without bleeding ("Think before reversing anticoagulants").

Second, hospitalists must communicate and document clear expectations and boundaries of responsibility when working with subspecialty consultants and surgeons ("A real pain in the neck" and "Beyond the scope").

Third, regardless of consultant and/or subspecialty expertise, hospitalists are still responsible for their own scope of practice within their training, background, and experience. Hospitalists should not blindly defer to a consultant, and conversations regarding patient plans of care should be memorialized in the patient chart ("Overreliance on subspecialty in a case of endocarditis").

Had the hospitalist in this case documented her initial conversation with the neurosurgeon with an explicit transfer of responsibility regarding the intracranial bleed, it is likely that the legal outcome would have been different. As it was, the neurosurgeon in this case was eventually dropped by the plaintiff.

Dr. Hospitalist, on the other hand, ended up settling with the widow for an undisclosed amount.

Dr. Michota is director of academic affairs in the hospital medicine department at the Cleveland Clinic and medical editor of Hospitalist News. He has been involved in peer review both within and outside the legal system.