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If you encountered this case, what would you do? What are the issues in this case?

Dr. Simpson

is a relatively new family practice physician in the community. The hospital where she worked previously had a policy that physicians were notified by phone of 'dangerously abnormal lab

values' (such as a very low serum potassium). During her morning rounds, Dr. Simpson had ordered electrolyte values on a pediatric patient. She assumed that if the values were significantly abnormal, she would be notified by telephone. The pediatric patient was found to be extremely hyponatremic. The policy at this hospital was for nurses on the floor to use their discretion in calling lab values to physicians in the absence of a specific request by the physician to 'call with results' when the original blood work was ordered. When Dr. Simpson returned to the hospital for evening rounds, she discovered the lab values and was extremely upset that she hadn't been called. While no permanent injury occurred, Dr. Simpson was alarmed to realize that the child had not received corrective treatment during the day. In frustration, Dr. Simpson slammed the chart onto the desk at the nurses' station and bitterly criticized the nursing staff. Later that evening, one of the nurse apologized to the family for the delay in treatment. She also noted that she really hoped Dr. Simpson was not as grouchy with them as she had been with the nurses.

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