Patient Care Errors and Management Issues in Healthcare: A Case Study

Facts of the Case

This case examines the patient Margaret Burns, who is a 63-year-old woman with a diagnosis of left occipital hemorrhagic infarct. In addition, the woman has several pre-existing medical conditions. After being placed in the nursing and rehabilitation facility, the patient was found to have symptoms of deep vein thrombosis in the right leg and elevated white blood cell count. Due to her existing health condition, she cannot be prescribed anticoagulation therapy. Due to these circumstances, it was decided to move her to the acute care hospital for possible filter placement.

Carol Stevens, who handled the case, sent the patient’s incorrect medical records to a medical organization. This happened because of work overload and the woman’s personal problems. Because of this, the patient received unnecessary medications, which led to an extension of hemorrhagic stroke and her transfer to the ICU for further treatment.

Quality Improvement Tool

The mapping process becomes a quality improvement tool that can be effective in this case. This approach consists of creating a “flowchart as a picture of the sequence of steps in a process” (Buchbinder & Shanks, 2016, p. 160). This method will provide an understanding of all the processes and solutions that led to the problem and will help identify what went wrong and what was done incorrectly.

Management Issues

In the case under study, several management problems can be identified that led to an undesirable outcome in providing medical care to the patient. First of all, this is communication and coordination in the workplace, which consists of overloading employees, which causes problems with the transfer of patient records. The second problem is the inability to determine the effectiveness of prescribing medications to a patient in a healthcare facility. The third issue was the lack of measures to ensure quality care and correct treatment.

Among the legal and ethical obligations that a healthcare organization has to its patients and families, the duty of care stands out the most. In other words, the medical institution failed to provide quality services that will take into account the patient’s condition. Another obligation is to ensure that consent is obtained for the provision of services and transfer to another institution, which leads to negative consequences and discretion on admission.

Reference

Buchbinder, S. B. & Shanks, N. H. (2016). Introduction to health care management. Jones & Bartlett Learning.

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StudyCorgi. (2025) 'Patient Care Errors and Management Issues in Healthcare: A Case Study'. 31 January.

1. StudyCorgi. "Patient Care Errors and Management Issues in Healthcare: A Case Study." January 31, 2025. https://studycorgi.com/patient-care-errors-and-management-issues-in-healthcare-a-case-study/.


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StudyCorgi. "Patient Care Errors and Management Issues in Healthcare: A Case Study." January 31, 2025. https://studycorgi.com/patient-care-errors-and-management-issues-in-healthcare-a-case-study/.

References

StudyCorgi. 2025. "Patient Care Errors and Management Issues in Healthcare: A Case Study." January 31, 2025. https://studycorgi.com/patient-care-errors-and-management-issues-in-healthcare-a-case-study/.

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