ED Legal Letter
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EDs See Decrease in Low-Severity Illnesses, More Advanced Imaging
Perceived litigation risk has been often cited as one of the top reasons for ordering low-value imaging in many settings, including the ED. Higher costs and more radiation exposure (and hospitalizations) probably could have been avoided in many cases. Yet EPs know it is possible they will be sued for failing to order a diagnostic test.
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Home Monitoring to Determine Hospitalization Needs Among Discharged COVID-19 Patients
Discharging patients with a low-cost tool to monitor their own health can improve patient safety outcomes.
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ED Boarding Prolongs Length of Stay for Trauma Patients
One department changed its processes to reduce the number of patients who left without being seen — specifically, working to put a patient in front of a clinician faster. When the ED fixed this issue, door-to-doctor times and door-to-disposition times shortened significantly, and leave without being seen rates declined sharply.
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Vascular Complications Common Allegation in Lawsuits Against ED Nurses
It is unclear whether the claims involved IV infiltration, thrombophlebitis, pain caused by multiple sticks, or inadvertent arterial placement. Prevention efforts might include procedural training, integration of ultrasound in IV placement, or escalation of patients with difficult access to providers who specialize in IV access.
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Artificial Intelligence Coming to EDs to Improve Stroke Diagnosis
Strokes, especially posterior circulation events, are associated with significant diagnostic error in the ED. Machine learning models can be designed to capture subtle signs and assist providers in catching cases that might otherwise go undetected.
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New ED-Specific Trigger Tool Identifies Most Important Adverse Events
The patient safety movement emphasizes the need to focus on detecting harm — ideally, preventable harm — rather than just errors. Instead of remaining hidden, adverse events should be identified and shared.
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Length of Time in ED Linked to Patient Safety Events
The odds of a patient safety event (defined as a near-miss event or adverse event) increase by 4.5% for every additional hour a patient stays in the ED, according to the authors of a recent study.
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Hospitals Mistakenly View Boarding as an ‘ED Problem’
Since hospitals rely on elective surgeries for financial viability, patients admitted from the ED tend to be a somewhat lower priority. Asking hospital administrators to observe the risks of ED boarding firsthand can help change this perception.
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Partly Driven by Defensive Medicine, ED Imaging Orders Rise Dramatically
Investigators analyzed advanced Medicare imaging use and paid malpractice claims, examining claims data for a 5% sample of Medicare beneficiaries from 2004 to 2016 and the National Practitioner Data Bank. For every 1% increase in the number of paid malpractice claims, there was a corresponding 0.20% increase in advanced imaging use.
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Crowding Tied to Higher Mortality Rate, Even After Discharge
Patients are more likely to leave without being seen when care is delayed because of ED crowding. A researcher recently concluded that if patient volume is alleviated by just 10%, it significantly lowers the average patient’s chance of mortality.