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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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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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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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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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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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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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Obtaining an EKG in a timely manner is critical, says Brian W. Selig, MHA, BSN, RN, CEN, NE-BC, nurse manager of the ED at the University of Kansas Hospital in Kansas City, MO, especially with the recent emphasis on time-critical diagnosis by the Joint Commission and [the Centers for Medicare & Medicaid Services.]
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An elderly womans bruising and gastrointestinal bleeding turned out to be caused by taking more than triple the dose of her warfarin medication for several days, reports Jeannette Witzel, RN, CEN, an ED nurse at Ukiah (CA) Valley Medical Center.
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If procedural sedation is longer-term, or if your patient has pre-existing chronic obstructive pulmonary disorder, consider monitoring end tidal carbon dioxide (CO2), advises Leah M. Gehri, RN, MN, CCRN, director of emergency, trauma, and cardiac services at MultiCare Good Samaritan Hospital in Puyallup, WA.
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ED nurses at Mount Desert Island Hospital in Bar Harbor, ME, have dramatically shortened door-to-CT and door-to-drug times with a Code Stroke program, reports Sean Hall, RN, one of the hospitals ED nurses.