A 90-year-old male was brought to the ED by EMS for evaluation after a fall. This was an unexceptionally busy shift, and it seemed like the EMS phone never stopped ringing. I was not in the room when the patient arrived, and therefore did not receive hand-off from EMS. By the time I saw the patient, he was already in a gown and cleaned up.

The family reported that he had fallen just prior to arrival, and gave no indication that anything else was going on. I examined the patient and he had no pain anywhere, except for an abrasion on the left shoulder. The family felt comfortable taking him home and stated that they just wanted him checked out. When I talked to Dawn about sending the patient home, she questioned the plan and told me that the patient appeared very unkept/dirty when he arrived. She was concerned that he was not receiving adequate care at home and encouraged me to dig a little deeper. Luckily, she pressed me on the issue because the patient turned out to have rhabdomyolysis and acute kidney injury, requiring admission and likely nursing home placement after discharge.

With the ED being so busy it would have been easy for Dawn to agree with my assessment and allow the patient to go home. We rely on the nurses to obtain that extra bit of information if we are not in the room when they arrive, or if the family is not reliable with the history. She went the extra mile for this patient, and I am truly grateful for her excellent care.