CASE ASSIGNMENT: MRS.

NAVARRO’S DISTENDED ABDOMEN

In Partial Fulfillment of the Requirements for the Course:

Quality Assurance in Hospital Administration for the Program:
Master in Management Major in Hospital Administration

SUBMITTED BY:
GROUP 2
JULIE ABITRIA-MAUREAL, MD, DPOGS
REBECCA ANN GABOR, MD, FPOGS
MICHAEL THOMAS MONTESA, MD, FPOGS
ROJANNAH SAHAGUN, MD, FPOGS
WINNIE LORRAINE UMALI-PASCUAL, MD, DPOGS
CASE: Mrs. Navarro’s Distended Abdomen

Mrs. Ofelia Navarro a 48-year-old retired teacher was seen by the IM Department due
to abdominal enlargement. Abdominal Ultrasound showed a huge ovarian mass
compressing and displacing the bowels. Patient was referred to OB-Gyne Department
who placed patient on OPD consult. Patient went back regularly and patiently despite
the long line of patients as scheduled. She has been seen by medical interns and
residents for the past three months. Every consultation the diagnosis of Ovarian Mass
probably New Growth is being discussed to patient. No further work up were added
during the entire three months of tedious going back and forth.
Mrs. Navarro on the other hand was asking when will she be operated. She would
always be informed that OR Schedules are full. Tired of waiting and getting weaker
every day, she went back to the IM department who in turn followed up the case to OB -
Gyne.
Eventually the Senior Resident brought the case to the attention of the consultant. Who
in turn asked the patient to be referred to Surgery Department for co- management.
Surgery saw the patient, reviewed the work - ups and recommend to build up the
patient.
Consultants of Both OB – Gyne Department and that of Surgery do not regularly report
to the hospital. They will come once in month though they are on regular plantilla.
Their monthly report of mortality and morbidity seems to be benign. Although the IM
department will regularly complain that both OB and Surgery do not accomplish their
operative technique report. It was never attached to the charts of patients being referred
to them. Likewise surgical cases get postponed most often
On the fourth month of waiting Mrs. Navarro died.

Guide Questions:
1. As chief of clinics how will you address the poor management of this case?
 Will conduct a meeting with all the department concern
 Review of chart of the patient
 Review of standard operating procedures for interdepartmental referral
 Review of OR logbook schedule
 Review of standard operating procedure of OB-GYN department regarding
Gynecologic consult and operation schedule
 2. What is the ideal turn around time of inter-departmental referrals?
3. What measures has to be conducted to check for the quality of surgical and
obstetrical services that patient receives?
 Do case presentation and audit of cases seen
 Do random review of charts of outpatient, inpatient and ER consultation

4. What are the aspects to be reviewed and improved for Quality assurance?

5. What indicators can you identify that can serve as basis for improvement and
reviews?

6. How do you intend to check for the integrity of the different Department Services
to achieve a quality service?

 Monthly

method
Facilities

Full OR schedule no SOP for interdepartmental referral

No SOP regarding Gynecologic patient

assessment
DEATH OF

PATIENT

Medical

Staff