ACUTE CARE BREACH ANALYSIS WORKSHEET
A structured tool for identifying deviations from hospital standards of care, linking failures to harm, and organizing breach arguments with clarity and precision.
This worksheet guides attorneys through the critical steps of evaluating breach in hospital and acute‑care cases. It helps compare what should have occurred to what actually occurred, identify deviations, and determine whether those deviations contributed to harm.
Use this worksheet during case screening, expert review preparation, deposition planning, and timeline reconstruction.
PATIENT & CASE OVERVIEW
Patient Information
• Name
• Age
• Primary diagnoses
• Admission source (ED, direct admit, transfer)
• Baseline functional status
• Baseline cognitive status
Key Dates
• ED arrival
• Admission
• Incident or deterioration
• Transfer to ICU or higher level of care
• Discharge or death
EXPECTED STANDARD OF CARE
Identify Applicable Standards
• Hospital policies
• National guidelines (AHA, ACEP, SCCM, etc.)
• Evidence‑based practice
• Physician orders
• Nursing standards of practice
Document What Should Have Happened
• Required assessments
• Monitoring frequency
• Diagnostic timelines
• Escalation protocols
• Interdisciplinary communication
• Documentation expectations
ACTUAL CARE PROVIDED
Document What Actually Happened
• Nursing assessments
• Provider evaluations
• Diagnostic orders and timing
• Interventions performed
• Medication administration
• Monitoring frequency
• Escalation actions
• Documentation entries
Identify Gaps or Inconsistencies
• Missing notes
• Contradictory entries
• Delayed documentation
• Unexplained changes
• Copy‑paste patterns
• Vitals or assessments not charted
IDENTIFIED DEVIATIONS (BREACH POINTS)
List Each Deviation Clearly
• Delayed triage or assessment
• Delayed provider evaluation
• Delayed diagnostics (labs, imaging, EKG)
• Failure to monitor
• Failure to reassess
• Failure to escalate (no rapid response)
• Medication errors
• Poor communication
• Documentation failures
For Each Deviation, Answer:
• What should have occurred?
• What actually occurred?
• Why is this a breach?
• What evidence supports this?
• What was the expected outcome if handled correctly?
CAUSATION LINK
Did the deviation contribute to harm?
• Yes / No / Possibly / Unclear
Describe the Connection
• How the breach increased risk
• How the breach led to deterioration
• How earlier intervention could have changed the outcome
• Whether harm was foreseeable
Supporting Evidence
• Medical records
• Diagnostic timestamps
• Vital sign trends
• Expert opinions
• Hospital policies
• Timeline reconstruction
TIMELINE RECONSTRUCTION
Build a Clear Sequence of Events
• Time of arrival
• Triage level
• First provider evaluation
• Diagnostic orders and results
• Interventions performed
• Change‑in‑condition events
• Escalation actions
• Transfer or discharge
Identify Delays
• Late EKG
• Late imaging
• Late antibiotics
• Late provider notification
• Late rapid response activation
COMMON ACUTE‑CARE BREACH INDICATORS
• Delayed recognition of deterioration
• Missed abnormal vital signs
• Failure to escalate to rapid response
• Delayed diagnostics (CT, labs, EKG)
• Delayed antibiotics (sepsis)
• Missed stroke indicators
• Medication errors
• Poor handoff communication
• Incomplete or inaccurate documentation
These are the most frequent breach themes in hospital litigation.