I feel that your article [“Admit or Not?”, May 2017] in ACEP Now was a bit too kind toward physicians who order blood cultures on patients and discharge them from the ED. Your case example was a poor one on which to take your stand, and the plaintiff expert in this case was a terrible witness.

In my opinion, ordering a blood culture and discharging a patient to home care is a recipe for disaster. I’ve been involved in at least two cases resulting in serious disability from staphylococcal spinal epidural abscess in patients whose back pain was the trigger for ordering a blood culture. As usual, other factors also played a role, but had either patient been admitted, the diagnosis would have been made while there was still time to do something about it.

But the bigger problem is that physicians must 1) know the risk entailed in sending a patient home with a pending blood culture, and 2) document one’s rationale for discharging a patient with pending blood cultures. It’s okay to be wrong— as in the case you presented—but not to document your medical decision making in a risky situation like this is below the standard of care.

– Charles A. Pilcher, MD, FACEP
Kirkland, Washington