Nurses are supposed to contact people after outpatient surgery, but it is not clear whether a deficiency at Rhode Island Hospital contributed to the death of an 80-year-old man in July.

01:00 AM EDT on Tuesday, September 28, 2004

BY FELICE J. FREYER
Journal Medical Writer

A Health Department investigation into a man's death after surgery at Rhode Island Hospital found that nurses failed to adequately follow up with patients when they left the hospital after outpatient surgery.

But it is not clear whether this deficiency -- the only flaw in hospital procedures that the inspector found -- was a factor in the July 17 death of 80-year-old Peter Sepe, of Warren. Sepe died of a blood infection two days after a surgeon pierced his small intestine during a gall-bladder operation.

Hospital spokeswoman Nicole Gustin said that nurses attempted to reach Sepe after he left the hospital, but failed. He later returned to the hospital, where he died of the infection.

Meanwhile, the state Board of Medical Licensure and Discipline is still investigating Sepe's surgeon, and the state Board of Nursing is examining the actions of a nurse involved with his care.

Asked whether the hospital had placed any restrictions or monitoring on Sepe's surgeon, Gustin said such information is secret.

She said that whenever a complication occurs, a doctor undergoes a confidential process of "peer review," in which other doctors assess what happened. "At the end of the peer review, if we find that we need to make improvements, we make those," Gustin said. But she said she could not reveal whether any action was taken regarding Sepe's surgeon, who has not been publicly identified.

The hospital is considering changes to its procedures regarding contact with patients after outpatient surgery, in response to the Health Department findings.

Sepe underwent a common procedure to remove the gall bladder without cutting open the abdomen. The surgeon inserts long instruments into several small incisions, including a tiny video camera that enables the surgeon to watch the procedure on a television screen. This method results in less pain and faster recovery for patients, but the surgeon can only see the small area where the camera is pointing.

During Sepe's surgery, the surgeon pierced the small intestine, which even in healthy people is full of germs. That led to the deadly infection. Piercing the small intestine is a known risk of this surgery, but not a common complication.

As required by law, the hospital reported the incident to the Health Department. The facilities regulation division studied outpatient surgery policies at the hospital, and examined the records of nine patients who underwent outpatient surgery during July.

Hospital policy required nurses to contact patients within 24 hours of surgery and ask a list of questions to see whether patients were experiencing complications or having difficulty understanding instructions given upon discharge.

But in five of the nine cases, nurses failed to reach the patient, according to the Health Department report. In three cases, there was no evidence that any attempt had been made to contact the patients. In two cases, there was no evidence of a second attempt to to reach the patients when the first attempt was unsuccessful.

Gustin said that when a nurse reaches an answering machine, she or he is prohibited from leaving a message because it would violate patient confidentiality. The hospital is considering asking patients to sign a form if they don't mind receiving voicemail messages.

The hospital is now requiring nurses to note in the medical record every attempt to reach a patient after surgery. The hospital is considering requiring a second phone call if the patient isn't reached with the first one and also requiring that attempts be made for 48 hours, Gustin said.

The hospital has also been keeping track of its post-surgery followup efforts. Gustin said that in the past month, nurses successfully contacted 94 percent of patients.