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There is nothing like working on the front lines in a busy emergency department to learn about the impact of traumatic injuries. Consider, for example, the experiences of Brent Parry, NREMTP. Serving as a paramedic for LifeFlight, and as a tech for the ED at Geisinger Wyoming Valley (GWV) Medical Center in Wilkes-Barre, PA, Parry is often among the first to see patients who have been seriously injured.
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Pediatric stroke remains one of the top 10 causes of death in children, with a mortality rate of 0.6 deaths per 100,000 strokes, and almost all of those affected have a residual neurologic deficit.
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An elderly man presented to an emergency department (ED) with new-onset chest pain. In reviewing the patient's electronic medical record (EMR), the emergency physician (EP) noted a history of "PE," but the patient denied ever having a pulmonary embolus.
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In one case involving the death of a 9-year-old girl from a reaction to metoclopramide, misdiagnosed as gastroenteritis, the patient and her 16-year-old brother were called on in the ED to interpret for their Vietnamese-speaking parents.
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If the hospital isn't named in a medical malpractice lawsuit, an emergency physician (EP) defendant can sometimes take advantage of the "empty chair" defense strategy, says Joseph P. McMenamin, MD, JD, FCLM, a partner at Richmond, VA-based McGuireWoods LLP and a former practicing EP.
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Whether an emergency physician (EP) has deviated from the accepted standard of care on the basis of timeframe depends on the facts of the individual case, says Robert D. Kreisman, JD, a medical malpractice attorney with Kreisman Law Offices in Chicago.
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The most significant legal risks in the ED are not those associated with boarding patients or high-acuity traumas, but rather, those associated with relatively stable patients with undifferentiated diagnoses, according to an analysis of malpractice cases occurring from 2006 to 2010 from Crico Strategies' Comparative Benchmarking System database.
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Measuring the number of ED malpractice claims that are avoided by calling patients post-discharge is difficult, acknowledges Jeanie Taylor, RN, BSN, MS, vice president of risk services for Emergency Physicians Insurance Company (Epic) in Roseville, CA. "It is hard to measure what did not occur, so the effectiveness of callback programs from a claims perspective is largely anecdotal," she says.
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My mother was on warfarin for a number of years and her degree of anticoagulation was difficult to manage. She had a number of complications, including bleeding episodes. So, I was enthusiastic about these new anticoagulants with their more predictable therapeutic effect. As with all new drugs, there are downsides; currently the lack of a readily available coagulation test to assess if there is a significant coagulopathy and an effective reversal agent. As these drugs are increasingly used, emergency physicians will see patients such as the three cases presented below.
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With surging demand from patients with both medical and mental health needs, and continuing pressure to reduce costs, ED managers have a full plate of concerns to contend with.
