Holly Rutledge, BSN, RN

Holly Rutledge, RN, was caring for a 3‑year‑old male who presented to the Emergency Department with vomiting and headache. The child’s parent reported that he had fallen from his bed while playing with his sister the night before, without loss of consciousness, and had attended pre‑K that morning. Prior to arrival, the parent noted that her son was “not acting right” and was experiencing persistent headache with associated vomiting.

During her assessment, Holly observed that the child was difficult to arouse, interacted minimally, and demonstrated nystagmus on eye exam. Recognizing these concerning findings, Holly advocated for CT imaging to rule out a head injury. This exemplifies our Safety Behavior of Acting with a Questioning Attitude and use of the Question and Confirm error‑prevention tool.

The initial CT showed no acute findings. During the remainder of the workup, the child tested positive for strep A, and plans were made for discharge by the APP and attending physician. Despite this, Holly was not comfortable with the patient’s condition. She spoke up for Safety and escalated her concern using the ARCC framework, approached the oncoming attending physician, and insisted on reevaluation.

As a result of Holly’s advocacy, the patient was ultimately transferred to Children’s Healthcare of Atlanta. Upon secondary review of the CT images, the child was found to have a skull fracture of the left occipitomastoid suture, suspected venous sinus thrombosis, and blood in the middle ear and mastoid.

Holly’s persistence, critical thinking, and unwavering commitment to patient safety ensured that this child received timely, definitive care and significantly improved the likelihood of a positive outcome. Her actions exemplify the compassion, courage, and clinical excellence the DAISY Award celebrates.