Medical Scribes can learn medical terminology and familiarize themselves with medical procedures by watching videos and discussing scenarios like the one below.
By Walter Rodriguez, PhD and Valerie Weiss, MD
Pedro Ramirez is a 67-year old retired veteran who had a routine prostate biopsy in an outpatient hospital facility on Thursday. He was released in the late afternoon and went home with his wife, Gladys. Pedro had a heavy dinner and watched TV with Gladys in their family room. Pedro complained of feeling “crummy” but nothing that a little rest couldn’t fix. Gladys went to bed at 9:30 p.m. leaving him alone. When she awoke at 6:00 a.m. on Friday, and he wasn’t in bed beside her, she went downstairs and found him lying on the family room floor. He was extremely drowsy, shivering, and had urinated on himself.
Gladys called 911. The local EMS arrived and asked his wife what happened. She told them about the prostate biopsy, and that he was fine before she went to bed. She reported that Pedro had taken pre-operative antibiotics, but she didn’t know the name of the antibiotic or dosage. She wasn’t sure which medications he took regularly, as there were many bottles on his dresser.
Symptoms of Sepsis
Pedro was drifting in and out of consciousness and was only able to answer the question pertaining to his name. He was taken by ambulance to the local hospital (different than the hospital affiliated with the outpatient facility). The EMS professionals told Gladys to get dressed and meet them at the hospital. Once in the ER, the attending nurse tried to get some pertinent information from Pedro. Unfortunately, all he recalled was his biopsy. Pedro’s vital signs showed:
Temperature of 102.5 degrees F
Blood pressure 88/68 mmHg
Pulse of 122 beats per minute
Respiration rate of 32 breaths per minute
His blood pressure was dropping--he was going into shock.
Coordination of care
Gladys arrived and was told that her husband would be fine; she did not need to worry. However, she was unable to provide any more insight or a list of his meds. She did not know his baseline vital signs. It was Pedro’s first ER experience in this hospital so he had no prior records on file. The ER doctors determined he was in septic shock and once stabilized would be moved to a critical care unit for recovery. Once stabilized, Pedro was able to provide a list of his meds to the nurses. The hospitalist came to see Pedro who said he would contact his primary care physician (PCP) to provide an update. During the next two days (the weekend), numerous tests were administered to Pedro to test for the function of his heart, kidney, liver, etc.
The hospital staff was unable to gain his medical records from the outpatient facility where the prostate biopsy was performed because it was done in another hospital system. On Monday, they were considering a pacemaker because his heart rate was so low. Frustrated by all of the uncertainty, his wife Gladys called the PCP and asked why she wasn’t involved. Dr. de' Medicis, the PCP, said the hospitalist never notified her that her patient of 15 years was in the hospital. She also told Gladys that Pedro had a very low resting heart rate when well and that his current heart rate was normal! At that moment, Dr. de' Medecis (PCP) stepped in and coordinated Pedro’s care with the hospital.
2. How would a Medical Scribe assist the Hospitalist and/or the PCP in this scenario?