A 46-Year-Old Man Is Hospitalized with Diabetic Ketoacidosis

A 46-year-old man is hospitalized with diabetic ketoacidosis.  He is administered intravenous fluids and an insulin drip, and laboratory testing is ordered.  In the morning, the on-call physician hands off the patient to the day shift physician, who arrives an hour late due to an emergency at his nighttime moonlighting job.  The handoff information includes the status of the patient and instructions to check electrolytes and calculate his anion gap.  The physician performs inpatient rounds and then sees his usual clinic outpatients in the afternoon, but he neglects to check the patient's anion gap.  The patient subsequently develops worsening acidosis requiring intubation for respiratory distress.  Which of the following is the most likely cause of this adverse outcome?

A) Deficiency of knowledge
B) Excessive patient caseload
C) Inadequate patient handoff
D) Judgment error
E) Physician burnout
F) Physician fatigue

Correct Answer:

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