Amputation Part 1

Case Study: Amputation Part 1

Mr. Rivera is a 63-year-old obese patient with uncontrolled type 2 diabetes. He has lost significant mobility and uses a wheelchair. He has had a nonhealing wound in his left foot for the past 2 months; the foot is now gangrenous. Mr. Rivera was admitted to the hospital 2 days ago to amputate his foot at the ankle. Although the surgery went reasonably well, 2 days after the surgery, Mr. Rivera developed a fever, and the tissue around the stump became red and warm to the touch. During morning rounds, the hospitalist recommends that the patient be discharged. However, the surgeon fears an infection is developing and recommends the patient remain hospitalized.

Discussion Questions

1. In what ways might interprofessional collaboration be improved in the care of Mr. Rivera?
2. Which interprofessional team members, besides the two mentioned, could have been involved in this decision?
3. What significant roles can Mr. Rivera and his family play on the interprofessional team? Explain.
4. Propose how disagreement might be resolved by using the appropriate Sub-competencies.
5. Which healthcare professional is ultimately responsible for this patient? Provide your rationale.

1. Improving Interprofessional Collaboration:
   • Regular and structured team meetings: Scheduled meetings where all involved healthcare professionals discuss the patient’s progress, concerns, and potential complications could improve collaboration.
   • Clear communication channels: Establishing effective communication methods between team members, such as through electronic health records or secure messaging systems, can facilitate quick information exchange.
   • Defined roles and responsibilities: Clearly outlining each team member’s responsibilities and contributions to the patient’s care can prevent misunderstandings and ensure everyone is on the same page.
2. Additional Interprofessional Team Members:
   • Wound care specialist: Given the nonhealing wound and the development of gangrene, a wound care specialist could offer expertise in wound management and care.
   • Infectious disease specialist: In situations where infections are suspected, involving an infectious disease specialist can aid in diagnosing and managing the infection effectively.
   • Diabetes educator/nutritionist: Considering Mr. Rivera’s uncontrolled diabetes and obesity, a diabetes educator or nutritionist could contribute to managing his condition and preventing further complications.
3. Roles of Mr. Rivera and His Family:
   • Advocacy and support: They can advocate for Mr. Rivera’s needs and concerns, ensuring his voice is heard in the decision-making process.
   • Care coordination: They can assist in coordinating appointments, medication management, and at-home care instructions, thereby supporting the interprofessional team’s efforts.
   • Emotional support: Providing emotional support and encouragement can positively impact Mr. Rivera’s mental and emotional well-being during his treatment and recovery.
4. Resolving Disagreement using Sub-competencies:
   • Communication: Encourage open dialogue between the hospitalist and surgeon to understand each other’s perspectives and concerns regarding the patient’s condition.
   • Conflict Resolution: Utilize conflict resolution techniques such as negotiation, compromise, or seeking a third-party mediator to reach a consensus on the best course of action for Mr. Rivera’s care.
   • Teamwork and Collaboration: Emphasize the importance of collaboration and teamwork, focusing on the shared goal of providing the best care for the patient.
5. Ultimate Responsibility:
   • The primary responsibility lies with the healthcare team as a whole. However, the attending physician or the surgeon directly responsible for Mr. Rivera’s surgery might have a higher level of accountability for overseeing his immediate post-operative care.

In complex cases like Mr. Rivera’s, multiple healthcare professionals collaborate, but a specific physician, typically the attending or primary surgeon, often assumes overall responsibility for the patient’s care and treatment decisions.