Patient Care
1.5 Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment.
On my Mini-I rotation with the family medicine service at OSU East I had the opportunity to see and evaluate a multitude of patients with many different presentations. One particular instance when I was working the overnight shift was very educational and stands out in my mind. On the overnight shift, it was only myself and the second year resident on service, so we were responsible for any admissions that came in through the evening and night. Together, we were in the process of admitting a patient who had been diagnosed with acute pancreatitis in the emergency department. I was familiar with the very basics of how to care for this condition such as giving IV fluids and making the patient NPO, but I had never actually cared for a patient with this condition so I was unfamiliar with the specifics of exactly what to order for them. I knew that I needed some more information to take care of this patient. The resident was more familiar with the diagnosis and what exactly to do but also wanted to review to make sure we were not missing anything. When we returned to the work room after taking the patient’s history and performing an exam, I decided to look to see if there was a clinical practice guideline for acute pancreatitis. I found that OSU did have a great and concise guideline that outlined what steps to take in the process of caring for a patient with acute pancreatitis.
While the resident was working on some documentation and returning calls, I reviewed this guideline and put in orders for the items that we did not think to order yet, such as a RUQ ultrasound, triglycerides, CRP, and calcium. I also changed the patient’s fluids from LR to normal saline since we did not have a calcium for her yet. Unexpectedly, the RUQ ultrasound that I ordered because of this clinical practice guideline actually revealed an unknown hepatic abscess. Although it is questionable whether this was directly related to the patient’s pancreatitis, it was absolutely something that needed to be treated and the patient ended up getting the abscess drained by the IR team. The team was very impressed that I had been the catalyst for this workup and this was an occasion where I truly knew I had made a massive difference in the care of a patient. Because of this patient, I will definitely always remember what tests and procedures to run when I encounter a patient with acute pancreatitis, and I will always look to see if there’s an OSU clinical practice guideline for the diagnoses that I am involved in treating.
Goal:
I will review an OSU clinical practice guideline at least once per month to familiarize myself with common presenting conditions that I have encountered in my rotations. This will be tracked via a google doc and calendar that I use to organize my schedule and activities.