HOSPITAL TIMELINE RECONSTRUCTION TOOL
A structured template for rebuilding the patient’s clinical timeline, identifying delays, and highlighting deviations from hospital standards of care.
Hospital cases often hinge on the sequence of events: when symptoms began, when staff recognized deterioration, when diagnostics were ordered, and how quickly interventions occurred. This tool helps attorneys reconstruct the patient’s clinical timeline with clarity, identify delays, and expose deviations from expected hospital care.
Use this tool during case screening, breach analysis, expert review preparation, and deposition strategy.
BASELINE TIMELINE
✔ Establish Baseline
• Admission date and time
• Source of admission (ED, direct admit, transfer)
• Baseline vitals
• Baseline mental status
• Baseline functional status
• Pre‑existing conditions
• Home medications
✔ Identify Initial Risks
• Fall risk
• Infection risk
• Cardiac risk
• Respiratory risk
• Medication risk
• Stroke risk
EMERGENCY DEPARTMENT TIMELINE (IF APPLICABLE)
✔ Document ED Events
• Arrival time
• Triage level
• First provider evaluation
• Initial diagnostics (labs, imaging, EKG)
• Interventions performed
• Pain management
• Change‑in‑condition events
• Time of admission decision
✔ Identify Delays
• Delayed triage
• Delayed provider evaluation
• Delayed EKG
• Delayed imaging
• Delayed antibiotics
• Missed abnormal vital signs
INPATIENT DAILY TIMELINE
✔ Nursing Documentation
• Shift assessments
• Vital sign trends
• Pain assessments
• Intake/output
• Skin checks
• Mental status changes
✔ Therapy & Ancillary Notes
• PT/OT
• Respiratory therapy
• Dietary
• Case management
✔ Provider Documentation
• Rounds
• Consults
• New orders
• Reassessments
• Diagnostic interpretations
✔ Identify Gaps
• Missing vitals
• No reassessment after interventions
• Contradictory notes
• Copy‑paste patterns
• Late entries
CHANGE‑IN‑CONDITION TIMELINE
✔ Reconstruct the Deterioration Event
• Time deterioration first noted
• Symptoms observed
• Vital sign changes
• Nursing reassessment
• Provider notification time
• Provider response time
• Interventions performed
• Rapid response activation (if applicable)
• Transfer to ICU
✔ Identify Delays
• Delayed recognition
• Delayed provider notification
• Delayed provider response
• Delayed rapid response activation
• Delayed diagnostics
• Delayed interventions
These delays are often the strongest breach indicators.
RAPID RESPONSE / CODE TIMELINE (IF APPLICABLE)
✔ Required Elements
• Time rapid response was called
• Time team arrived
• Patient condition on arrival
• Interventions performed
• Diagnostics ordered
• Recommendation for ICU transfer
• Time of transfer (if applicable)
• Patient outcome
✔ Identify Red Flags
• Staff hesitated to call
• Provider instructed staff to “wait and see”
• Rapid response called too late
• No rapid response despite clear indicators
POST‑INCIDENT TIMELINE
✔ After the Event
• Reassessment
• New orders
• Increased monitoring
• Diagnostic follow‑up
• Provider communication
• Family notification
• Transfer to higher level of care
✔ Identify Failures
• No reassessment
• No monitoring increase
• Delayed diagnostics
• Missing documentation
• No change in care plan
TIMELINE RED FLAGS (BREACH INDICATORS)
• Missing or incomplete documentation
• Delayed triage or assessment
• Delayed provider evaluation
• Missed abnormal vital signs
• Delayed diagnostics (labs, imaging, EKG)
• Delayed antibiotics (sepsis)
• Failure to escalate deterioration
• Failure to activate the rapid response
• Poor handoff communication
• Contradictory or retroactive documentation
These are the most common breach themes in hospital litigation.