case 23


Answer the questions following the case study.   

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Dialysis Access
Dale Buchbinder
Metropolitan Hospital has a large dialysis program. Many patients have dialysis access issues where they need to have their access sites fixed on an urgent or emergent basis. These access sites are catheters, arterial venous fistulas, or arterial venous grafts that have been placed in the patient for connection to the dialysis machine. Dialysis is life sustaining for patients in renal failure; access sites are literally lifelines.
Mr. Cavanaugh presented to the hospital dialysis center with a clotted dialysis graft. The surgeon was contacted and the patient was sent to the preoperative area. The patient had not been dialyzed in four days and the patient had not eaten that day. When the nurse received the results of the required routine blood work, she noted that the potassium was quite elevated. The nurse called the operating room and stated the case had to be canceled.
Dr. Jones, the surgeon, was outraged. He phoned the operating room and the nurse. An argument ensued, and words were exchanged. The nurse stated that it was unsafe to send the patient to the operating room with a high potassium level, because the patient could arrest. The surgeon stated the patient needed dialysis in order to lower the potassium. If Dr. Jones did not fix the dialysis access, the patient’s potassium would only get higher, which could be life threatening.
Finally, after a lengthy discussion with the anesthesiologist, the patient, and the nurse, reason prevailed and the dialysis access was appropriately repaired. The patient was monitored throughout the procedure by an anesthesiologist with no adverse outcome.
Discussion Questions
1.    What are the facts in this situation?
2.    What could have been done to avoid this confrontation?
3.    What are three organizational issues this case illustrates?
4.    Should the nurse have attempted to cancel the surgery without speaking to the surgeon?
5.    What steps should be taken in the future to prevent this problem from occurring again?
6.    Should other people have been involved in resolving this dispute? If yes, what roles could they have played in this resolution?
7.    Have you ever been involved in an ugly confrontation with a coworker? Looking back at that incident, knowing what you now know, what might you have done differently? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.
Borkowski, N. (2011). Organizational behavior in health care (2nd ed.). Sudbury, MA: Jones and Bartlett.
Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett.
Fallon, L. F., & McConnell, C. R. (2007). Human resource management in healthcare: Principles and practices. Sudbury, MA: Jones and Bartlett.
Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.
Ricci, M. A., & Brumstead, J. R. (2012, April). Crew resource management: Using aviation techniques to improve operating room safety. Aviation Space and Environmental Medicine, 83(4), 441–444.
Rogers, D., Lingard, L., Boehler, M. L., Espin, S., Klingensmith, M., Mellinger, J. D., & Schindler, N. (2011). Teaching operating room conflict management to surgeons: Clarifying the optimal approach. Medical Education, 45(9), 939–945.
Siu, H., Spence Laschinger, H., & Finegan, J. (2008). Nursing professional practice environments: Setting the stage for constructive conflict resolution and work effectiveness. The Journal of Nursing Administration, 38(5), 250–257.

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