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Quality measures from the Centers for Medicare & Medicaid Services (CMS) and other groups are putting EPs "in a huge bind," according to Sandra Schneider, MD, professor of emergency medicine at University of Rochester (NY) Medical Center.
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If there is absolutely no credible reason to think that a patient's symptoms are due to a heart attack, says John Burton, MD, chair of the Department of Emergency Medicine at Carilion Clinic in Roanoke, VA, you shouldn't be ordering tests such as cardiac enzymes.
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In this article, we present a series of actual clinical scenarios that could have turned out differently if the wrong management decision had been made.
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This is the first of a two-part series on liability risks involving ordering of diagnostic tests in the ED. This month, we'll cover the legal ramifications of deciding not to order a test, the legal risks of unexpectedly abnormal results, how ED protocols can help an EP's defense, and a new quality measure that increases liability risks for EPs.
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If you don't believe a diagnostic test is truly necessary but you order it anyway, you must be prepared for results to come back unexpectedly abnormal, even if these "incedentalomas" have nothing to do with what brought the patient to the ED, warns Bruce Janiak, MD, professor of emergency medicine at Medical College of Georgia in Augusta.
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Imagine a plaintiff's lawyer poring over stacks of documents provided by the defense as a result of a lawsuit alleging ED malpractice, and finding the statement, "This nurse will eventually kill a patient."
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Like many EDs across the country, the ED at St. Charles Medical Center in Bend, OR, sees its share of patients with urgent or primary care needs, and many of these patients frequent the ED 10 or more times a year.
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One new study suggests that crowding in the ED does not necessarily prevent patients who are having ST-segment-elevation myocardial infarction (STEMI) heart attacks from receiving needed treatment quickly.
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Faster throughput can clear waiting rooms and boost patient satisfaction, but there are also instances where time-to-treatment can make a critical difference in outcomes.
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The ED at Shands Critical Care Center at the University of Florida in Gainesville, FL, sees about 9,000 patients every year who present with chest pain, and until recently, a high percentage of the low- to moderate-risk patients were being admitted to the hospital for further observation.
