ED Legal Letter – December 1, 2020
December 1, 2020
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Advanced Practice Providers See More Complex Patients, Sued More Often
More ED patients are visiting physician assistants or advanced practice nurses. Of 54,722 closed malpractice claims analyzed in a recent study, about 75% of claims naming advanced practice providers also named physicians.
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Crowding Tied to Higher Mortality Rate, Even After Discharge
Patients are more likely to leave without being seen when care is delayed because of ED crowding. A researcher recently concluded that if patient volume is alleviated by just 10%, it significantly lowers the average patient’s chance of mortality.
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Stroke Care Not Significantly Delayed Despite Crowding
Findings provided some assurance EDs can address time-critical illnesses even when crowded, at least when it comes to stroke care. Additional study is needed regarding patients presenting with time-sensitive illnesses, but more vague complaints.
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Partly Driven by Defensive Medicine, ED Imaging Orders Rise Dramatically
Investigators analyzed advanced Medicare imaging use and paid malpractice claims, examining claims data for a 5% sample of Medicare beneficiaries from 2004 to 2016 and the National Practitioner Data Bank. For every 1% increase in the number of paid malpractice claims, there was a corresponding 0.20% increase in advanced imaging use.
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Angry Encounters Can Adversely Affect Clinical Decision-Making
A patient screams and spits at the emergency physician and nurse who are trying to determine if a life-threatening emergency exists. Another patient is extremely grateful, cooperative, and respectful. Assuming both patients presented with the exact same clinical situation, would ED providers treat them any differently? The authors of two recent studies examined this interesting question.
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Report Links ED Boarding to Worse Clinical Outcomes
Some hospitals have found a novel solution in the form of resuscitative care units, which are ICUs based in EDs. Patients who need time-sensitive respiratory, metabolic, neurologic, or hemodynamic critical care can receive it in the ED. This prevents these patients from waiting so long for a bed to finally open in the appropriate specialty ICU.
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Hospitals Mistakenly View Boarding as an ‘ED Problem’
Since hospitals rely on elective surgeries for financial viability, patients admitted from the ED tend to be a somewhat lower priority. Asking hospital administrators to observe the risks of ED boarding firsthand can help change this perception.
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Length of Time in ED Linked to Patient Safety Events
The odds of a patient safety event (defined as a near-miss event or adverse event) increase by 4.5% for every additional hour a patient stays in the ED, according to the authors of a recent study.