ED Legal Letter
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Few Hospitals Violating ‘Good Faith’ EMTALA Requirements for Admitted Patients
An ED patient is admitted, but then is transferred almost immediately. This kind of situation can call into question whether the admission was “good faith” or if the hospital was just trying to work around federal EMTALA requirements.
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Legal Implications for ED, Hospital if Triage Nurse Orders Testing
The authors of a recent analysis examined 13 studies about nurse-ordered testing at triage. Ten studies were about length of stay or time to diagnosis. The authors of the other three compared tests ordered at triage with tests ordered by emergency physicians. There were some surprising findings.
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Providers’ Misconceptions About ‘Duty to Warn’
If a patient expresses intent to harm an individual or a group while in visiting an emergency provider, that provider should try to warn the individual or group of possible harm and also contact law enforcement.
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Overusing CT Scans: Evidence of Decision-Making Helps Defense
Make it clear to patients, families, and anyone who reviews the chart later why a CT was not ordered during the initial visit. If the provider takes the time to explain this, the family is less likely to be angry if there is a delayed diagnosis. Without a discussion at the first visit, the family may believe a CT scan was not ordered because the physician did not take the complaint seriously.
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Alleviate Risks if Patients Leave Without Being Seen
There is a tendency to assume that if someone left the ED, he or she probably was not that sick. That is a dangerous assumption. For all patients who leave without being seen, the nurse manager should follow up with a call within 24 hours.
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Some Psychiatric Patients Can Bypass ED Altogether
Researchers considered protocols that bypass the ED by allowing EMS to directly transport patients to a specialized regional center for evaluation of psychiatric emergencies. The protocols are somewhat controversial.
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Better Patient Experience Mitigates Malpractice Risk
Any ED would benefit from teaching emergency physicians to be more aware of how patients perceive them. Engaging in role-playing exercises are helpful. Record the exercises so they can be critiqued.
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Incomplete Medication Lists Can Lead to Allegations of Negligence
Just 23% of older adults in the ED gave a medication list that mirrored pharmacy records, according to the results of an analysis. More than half the patients omitted antibiotics they were taking at the time of the visit. Not knowing about a medicine can lead to dangerous therapy or misdiagnosis.
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ED Nurses Also Face Liability for Misdiagnosis
The idea that it is not within the nurses’ scope of practice to contribute to diagnosis is both dangerous and wrong.
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Patients’ Easy Access to Records Means Complaints — and Chance to Avoid Litigation
Patients will no longer have to go through the discovery process during litigation to find out everything ED providers charted. Still, with patients reviewing all the clinical documentation, plenty of misunderstandings can happen.