Attachment F1 - Example of Management Review.pdf

CASE ID:

MANAGEMENT REVIEW REPORT

Case ID:

Patient Name:

Event date(s) to be reviewed: -

Episode of Care: -

Practitioner to be Reviewed:

Credential: MD/DO

Service/Specialty: Urology

WAS STANDARD OF CARE MET?

Yes

No

SPECIFIC QUESTIONS FOR REVIEWER:

year old underwent cystoscopy and bipolar TURP on by named urologist.

Veteran experienced gross hematuria post op and low hemoglobin. He was readmitted for recurrent gross hematuria requiring multipole transfusions. Veteran returned to the OR on for cystoscopy with evacuation of clots. Were the indications for the procedure on appropriate? Was the technique utilized by the named provider on appropriate? Was the documented post-op plan by the named provider appropriate?

SPECIAL INSTRUCTIONS:

Nothing needed

Attachment F1: Example of Management Review

CASE ID:

BRIEF CLINICAL SUMMARY/CASE OVERVIEW:

The veteran was a year old with a PMH of a. fib on Eliquis, CAD, sleep apnea, and BPH and was admitted on with hematuria attributed to Eliquis. Urology was consulted and a Community care Referral was placed for a HoLEP procedure. He underwent a bipolar TURP on . He developed tachycardia and hypotension at the end of surgery, requiring a transfusion and vasopressors, and was transferred to the ICU. He was discharged on . After he was restarted on Eliquis, he developed recurrent worsening hematuria. Veteran returned to the OR on for a cystoscopy with evacuation of clots.

SALIENT FEATURES OF THE CASE:

1. BPH

2. TURP

3. Post-op bleeding requiring transfusion and abd re-exploration

ANALYSIS THAT SUPPORTS THE DECISION:

The care provided was substandard. This patient was in urinary tension and was on anticoagulation. He underwent a transurethral resection of the prostate. Initially he was referred to community care for HOLEP. It is unclear if he had an adequate evaluation including a cystoscopy and/or cross-sectional imaging like an ultrasound or an MRI to appropriately evaluate the prostate size. It is possible that he may have had a very large prostate and thus may not have been the best candidate for a transurethral resection of the prostate. Other approaches like transurethral vaporization and HOLEP have a lower chance of bleeding in the postoperative period.

Indications for procedure were not appropriate. The issue was not with the technique or post -op plan, it was with the procedure of choice.

Most experienced and competent clinicians would have managed the case differently.

REFERENCES, IF APPLICABLE:

N/A

REVIEWER’S CREDENTIAL & SPECIALTY:

MD, Urology

All contract reviewers are required to provide an attestation that they are board certified, meet clinical qualification requirements, and have no conflict of interest, prior to being assigned to complete a VHA clinical review.