From Intensive to Primary Care: Bridging the Gap for Better Medicine

[摘要] Claire* was a female patient in her early twenties with long-standing, poorly controlled diabetes and a rare inherited disorder who had just been transferred to our general pediatric inpatient service. Initially, Claire was admitted to the floor of this pediatric hospital after presentation to the emergency department with a skin abscess that required intravenous antibiotic therapy after incision and drainage. Unfortunately, due to delay in presentation and her underlying medical vulnerabilities, the infection evolved into systemic inflammatory response syndrome, and Claire required admission to the ICU. After a week of noninvasive respiratory support, she was being transferred back to the general medical unit. Her acute clinical course had resolved, and now our team, composed of a hospitalist, consulting endocrinologist, residents, and medical students, was expected to send her home.At the time of transfer from the ICU, her discharge plan was all but signed. She would complete an oral antibiotic regimen and, at least according to the paperwork, follow-up with her endocrinologist, neurologist, and primary care physicians after discharge. Even before returning to the floor, her hospital discharge summary was written, medications pre-prescribed, and a list of follow-up appointments created. After all, her acute illness was resolved; she could go home.By most accounts, this patient was receiving high-tech, organized, and therefore sophisticated care. But after evaluating Claire as a team, it became clear that a few pieces of paper with instructions before discharge home would not suffice. Although Claire was a person with great humor and spirit, her life had been consumed by illness and personal struggle. Initially raised by an older relative because her parents were either deceased or uninvolved, she became a victim of abuse and subsequently spent her adolescence in foster care. Although she had finished high school and was an avid artist, she became …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob