Nicole was the CNC on shift for a patient who was hearing reports from multiple staff members of increased drowsiness and worsening mentation. The team had previously escalated to the physician about the change in condition, but the assigned physician was not concerned with the change, as the patient already had routine imaging ordered, and it would get done eventually.

This patient already had a known neurological abnormality due to a motor vehicle accident and a previous subdural hematoma. Nicole decided that she was not satisfied with the response and escalated her concerns to a physician consultant on the team and stressed the urgency of changing the imaging at 1104. The provider acknowledged Nicole's concerns and changed the Brain CT order from Routine to Stat.

Nicole then escalated to the CT team the importance of the test. The patient went to CT at 1140, and she then escalated the importance of the read again, and results were obtained by 1241. The results showed a worsening subdural hematoma and right-to-left midline shift.

A rapid response was initiated at 1304. During the rapid, the patient became drowsier and at times required continuous stimulation to remain alert. The patient was transferred to the Neuroscience ICU and was taken for Emergent Craniotomy Hematoma Evacuation by Neurosurgery at 1630.

Thank you, Nicole, for using your assessment skills, appropriate escalation, and maintaining patient safety. You truly saved this patient's life.