Assuming that Dr. Daytime-Hospitalist was correct and urgent or emergent surgery was necessary, he never spoke to the surgeon on call prior to Mr. B’s death. Dr. Daytime-Hospitalist would need to know the timing of the surgical intervention to know when to give the FFP. The plaintiff argued that the informed consent process requires accurate information to be provided before any consent can be given. In this case, there was never any indication to give the FFP, and whatever Dr. Daytime-Hospitalist told Mr. B was not accurate as a result.
Finally, to argue that the cause of death was not related to FFP, you would have to assert that Mr. B would have had shortness of breath followed by a respiratory arrest and death at 12:50 p.m. regardless of whether FFP was given or not. TRALI is a rare but known complication of FFP, and there was not an alternative explanation as likely as TRALI to explain the cause of death.
Conclusion
Anticoagulation poses significant challenges for the hospitalist.
Cessation of anticoagulation puts our patients at risk for thromboses, but to continue anticoagulation throughout a hospital stay increases the risk of bleeding, along with our ability to perform procedures or otherwise react to changes in clinical condition. Hospitalists must remember that anticoagulation reversal with blood products should not be taken lightly, and should never be used for expediency or "just in case."
In this case, Dr. Daytime-Hospitalist was "prepping" the patient for a presumed surgery. However, the use of blood products should have waited until the need and timing of the surgery were further defined. This case was ultimately settled in favor of the plaintiff 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 reported having no relevant financial conflicts.
