After being hit by a car, a young man in his twenties arrived in our emergency department in critical condition, with a severe head injury. I’m the trauma director at a bustling city trauma center and this was exactly the type of patient that I hate to see come in. He had absolutely nothing with him to identify him. The only clue to his identity was the location where the accident occurred, a busy city intersection. It was a hectic day in our ED and as patient after patient came through the doors, my staff and I kept telling ourselves that we would get down to the task of looking for the young man’s name and family as soon as our staff nurses had a few moments. After all, he was receiving the best care possible and that was the most important thing – wasn’t it?
The next morning, I began to wonder what became of our patient, who was now resting in the ICU. I went up to see him the first chance I got and when I looked at the still unconscious man’s chart, I couldn’t believe what I was seeing. No one had even begun to initiate a search. I immediately tossed everything else aside and tried to find clues to this man’s identity. By the end of the day, I had exhausted all of my resources. Nothing. My John Doe wasn’t doing well, in fact things were touch and go and I knew I’d have to do something quickly.
So I began with what I had – a physical description – which was difficult with the cranial and facial swelling. Asian male, dark hair, round face… I opened his eyes – which were a rich, warm brown. Knowing that he was lying in that bed alone, his family – if he had one – without a clue that he’d been critically injured, overwhelmed me. I sent the description over to the police, who began to canvass the area.
A day later, the police still hadn’t received any leads. In the meantime John Doe’s condition worsened.
I went up to the unit and decided to search through my patient’s clothes one more time. In the last pocket, I felt a piece of paper – a dog-eared business card for a grocery store a few blocks away from the intersection where the accident had occurred. I dialed the number and reached the owner of the store who had frantically been helping my patient’s mother search for him. To ensure I had the right person, I asked him a few questions. “He’s an Asian man, dark hair.” “No,” the grocer stopped me – “the boy we’re looking for isn’t Asian, he’s Caucasian and he has Down’s Syndrome”. I looked down at the patient. He was so swollen, that his eyes could easily been mistaken for being slanted, but on closer examination, the signs were unmistakable, my patient had Down’s. That’s what kept the police from realizing that my John Doe was their missing person.
He worked bagging groceries at the little store every day after school. He was on his way home when a car veered into the crosswalk, striking him just a few blocks from his house. My patient – Peter. Now he not only had a name, he had a family who rushed to his side. Despite the fact that he received the best care available, Peter died the next day, his mother at his bedside. Although my team and I were relieved we found his family in time, I felt horrible that two of his final three days were spent alone. And so did his mother. She stopped by to see me after her son had passed away and accepted my profuse apologies. Gracefully, I thought, considering what I might have done and said, had our situations been reversed.
Before she left, Peter’s mom looked me squarely in the eye. “You took wonderful care of my son physically and for that, I’ll always be grateful. As for not finding me right away, I won’t take that any further, as long as you promise me one thing. Every time a John Doe comes into this emergency room from now on, I want you to think about Peter and I want you to make sure that you do everything you can do, as soon as possible to bring that patient’s family to his bedside.”
I kept my promise. Thanks to Peter, a month later we not only had a brand new policy regarding John Does, but we had a system in place to handle next of kin notifications and a straightforward line of responsibility for performing them. Now when an unconscious patient comes into our ED everyone on our staff knows exactly what to do.
Learning how to deal with John Does is just ONE way to increase patient safety, health and satisfaction while reducing liability. We have many more...
Notify In 7 - The Seven Steps to Successful Notification System is filled with tools you and your ED/Trauma Staff can use to facilitate NOK notification, patient identification and communication.
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