After Rory Staunton's Death, Hospital Alters Discharge Procedures Three hours after the boy, Rory Staunton, left the emergency room, a laboratory test showed that his blood had extraordinarily high levels of cells associated with bacterial infections. He subsequently went into shock and experienced organ failure, and died three days later, on April 1. His parents said they were not told about the lab results and were unaware of how seriously ill their son was, having been assured that he was suffering from a typical stomach bug. In a statement, the hospital said that emergency physicians and nurses would be "immediately notified of certain lab results suggestive of serious infection, such as elevated band counts." Rory Staunton's bands, a type of white blood cell, were nearly five times as high as a normal level. The hospital has developed a new checklist to ensure that emergency department doctors and nurses have conducted "a final review of all critical lab results and patient vital signs" before a patient leaves, Lisa Greiner, a spokeswoman, said in the statement. "In the unlikely occurrence that a critically relevant test is only available after the patient is discharged from the E.D., the patient will be called, and the information will be shared with referring physician," Ms. Greiner said. The family pediatrician, who sent Rory to the hospital to be given fluids for dehydration, said she did not know about the blood work. Ms. Greiner said the steps were taken in direct response to Rory's death. "Keeping our patients safe is our first priority, and we want to prevent this situation from happening again," she said. Details of the boy's treatment and death were reported in The New York Times last week and have provoked vigorous discussions online and in medical-school classrooms and hospitals. Rory went into septic crisis a few days after cutting his arm while diving for a basketball at his school gym, most likely allowing bacteria into his blood. A consortium of 55 hospitals that has developed tactics for early diagnosis of sepsis will place "an enhanced focus on pediatric patients, for whom identification and treatment can be especially challenging," said Brian Conway, a spokesman for the Greater New York Hospital Association, which is leading the initiative. Many doctors have maintained online that Rory's symptoms when he was in the hospital, even if his blood results had been available, would not have distinguished him from run-of-the-mill ailments in children. Others, though, were alarmed by what they saw as evidence of glaring clues that were overlooked, poor communication, or a lack of flexibility in adjusting Rory's diagnosis. Joshua Needleman, a specialist in pediatric pulmonology at Weill Cornell Medical Center in New York, said the implications of the Staunton case went beyond ferreting out a specific disease and showed how important it was for doctors to keep open minds. "The big questions are about how to integrate new information that doesn't fit with the perception you have formed," he wrote in an e-mail. How to listen to the patient when they are telling you something that doesn't fit with your internal narrative of the case. These are the hardest things to do in medicine and yet the most important. Dr. Needleman said he planned to use details of the Staunton case to teach those points to medical students and was grateful that the boy's parents had disclosed the painful details. Dr. Robert E. Lynch, the director of pediatric critical care at Mercy Children's Hospital in St. Louis, said that Rory's lab results were "virtually incompatible with a diagnosis of viral gastroenteritis," which is what Rory was being treated for. "It's frustrating to be judged retrospectively," Dr. Lynch acknowledged. "Nevertheless, this case is why E.D."s exist - really good management saves lives. I know the boy may have died regardless, but all medicine does is change the odds. Drawing lessons from what happened to Rory will require an exploration of all the factors that influenced his care, said Dr. Paul Spirn, a radiologist with Beth Israel Deaconess Medical Center in Boston. Among examples he mentioned were the extent of communication between the hospital and Rory's pediatrician, and the procedures for alerting doctors and patients to urgent lab results after a patient has left the emergency room. "The Staunton case has the potential to yield far-reaching improvements in patient care," Dr. Spirn said.