A 77-year-old man with a history of chronic obstructive pulmonary disease (COPD) was admitted with a left hip fracture to the orthopedic surgery service, which has internal medicine hospitalists comanage its patients. The surgical repair went smoothly. On postoperative day 2, the patient was doing well when seen by the comanaging hospitalist. Later that day, the patient's oxygen requirement increased and the patient noted that he was feeling somewhat more short of breath compared to his baseline. The nurse notified the orthopedic surgery resident of the change in clinical status. A chest x-ray, ordered by orthopedics, showed new bilateral basilar consolidations. The orthopedic resident did not communicate these findings to the hospitalist, nor did he start antibiotics. The orthopedic resident assumed that the hospitalist was keeping up-to-date on developments and would initiate the appropriate treatment, while the hospitalist assumed that he would be contacted with any change in clinical status.
When the hospitalist next saw the patient (postoperative day 3), the patient was even more hypoxic. A computed tomography (CT) angiogram was done, which was negative for pulmonary embolism but showed much more extensive consolidations of his bilateral lung fields. He was started on broad-spectrum antibiotics; however, the patient's respiratory status continued to decline. He was ultimately transferred to the intensive care unit (ICU), intubated, and later died of hypoxic respiratory failure and sepsis (presumably from his pneumonia). It was believed that the delay in diagnosis of pneumonia and initiation of antibiotics may have contributed to the patient's downhill course.
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