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The first Dodging the Bullet article was written and published in the September 2011 issue of ED Legal Letter. In the earlier article, as well as this article, a series of actual clinical cases are presented that could have turned out differently if the wrong management decision had been made. The goals of this article remain the same as the earlier one: to glean important points of educational and teaching value from each of the reported high risk cases; and to highlight the fact that clinical misadventures are often a single judgment call away from a potential tragedy.
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Missed acute myocardial infarction (AMI) cases are usually top of mind when it comes to ED malpractice litigation, but other lesser-known clinical pitfalls also result in claims, warns Martin Ogle, MD, FACEP, senior partner and vice president of CEP America, an Emeryville, CA-based provider of acute care management and staffing solutions.
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When researchers at University Hospital Basel in Switzerland set out to study triage of elderly patients in their ED, they were surprised to find that 22.5% were undertriaged, reports Christian Nickel, MD, one of the studys authors and an emergency physician (EP).
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After a few mild seasons, the flu packed a wallop this year, straining resources in hospitals across the country and forcing some EDs to go on diversion during peak periods.
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Since mid-2004, The Joint Commission (TJC) has held all accredited hospitals to task for enforcing use of the Universal Protocol (UP), a practice designed to improve procedural safety by having clinicians go through a three-step process to insure that when they perform a procedure, they are performing the right procedure, on the right patient, in the right place.
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The emergency medicine community has pushed hard against complaints that too many patients with non-urgent needs are being seen in the ED, but there is little doubt that so-called super-utilizers patients who come to the ED regularly for one reason or another are not receiving the kind of care they need in the most appropriate setting.
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Health care has lagged behind other industries when it comes to leveraging the power of information technology (IT). However, in the race to catch up, which has been accelerated by $20 billion in federal stimulus dollars, ergonomists warn that hospitals and other health care entities are not giving adequate consideration to the potential for IT-related musculoskeletal injuries.
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Billing for the services provided by teaching physicians (TPs) continues to create problems for providers, coders, and compliance professionals due the many faces of documentation provided through electronic medical records (EMRs), template records, and handwritten charts.
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While new requirements are not always welcomed in the ED, to be sure, managers and front-line providers do have reason to feel optimistic about new standards, unveiled by The Joint Commission (TJC), regarding how hospitals manage patient flow.
