Night shift in the emergency department

Case 5: Diagnosis. ”Is this an emergency?” You are working the night shift in the emergency department, and as your images appear on the screen you notice that there is a 1-inch gap between the apex of the lung and the rib cage on the chest image for Mrs. Green. A few hours later you notice to your surprise that Mrs. Green is in the process of being discharged. You fear there has been a mistake and that the patient needs continued medical attention. The emergency department physician is busy with several other emergency patients, and the radiology resident is asleep.

Identify the problem. What is your obligation to the patient after you have completed the procedure? Should you act on the patient’s behalf even though you are not responsible for the diagnosis of the patient’s condition?

Investigate the problem. Should you speak to the patient or the nurse about the care the patient received? Can you look at the patient’s chart, or is this a Health Insurance Portability and Accountability Act (HIPAA) violation?

Formulate possible solutions. Should you address the emergency department physician or go to another source? What questions should you ask? What is the best way to question an authority figure in this case?

Select and enact the best solution. What aspects of the ARRT code of ethics might apply to this scenario? Is there a solution that will allow you to maintain a good working relationship with the physician while still acting in the interest of the patient?