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An expert witness for the plaintiff takes the stand and proceeds to tell the jury patently false statements regarding the standard of care. While this problem is certainly not unique to emergency medicine, it is exacerbated by the number of experts allowed by judges to testify based on limited exposure to emergency medicine, who are not themselves emergency physicians, says Hugh F. Hill III, MD, JD, FACEP, an assistant professor in the School of Medicine at Johns Hopkins University in Baltimore, MD.
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If an ED claims to have certain services available, that creates a duty to provide them, according to Douglas S. Diekema, MD, MPH, an attending physician in the ED at Seattle Childrens Hospital and director of education for the Treuman Katz Center for Pediatric Bioethics at Seattle (WA) Childrens Research Institute.
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Can the ED attending physician be held liable for a patients bad outcome even if he or she never saw the patient? In almost all cases, the answer is yes, at least to some degree, according to Kevin Klauer, DO, EJD, chief medical officer for Emergency Medicine Physicians in Canton, OH, and a member of the board of directors at Physicians Specialty Limited Risk Retention Group.
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Your hospitals public relations staff may jump at the chance to advertise that patients can expect to see a doctor within 30 minutes in your ED, but claims such as this could easily backfire if a lawsuit involves this issue.
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In one case that was eventually settled, an on-call specialist admitted making no effort to come in promptly, stating that traffic would be untenable for an hour because it was near the end of a Chicago Bulls playoff, recalls Tom Scaletta, MD, FAAEM, chair of the ED at Edward Hospital in Naperville, IL, and the emergency physician (EP) quoted the specialist verbatim to make it clear why a transfer was initiated.
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A plaintiffs attorney in a missed myocardial infarction case showed the jury an EMR entry indicating the patients heart rate was within normal limits, as well as vital signs taken by a nurses assistant showing severe tachycardia.
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Christiana Hospital in Newark, DE, averages between 315 and 320 patients per day. It's a huge ED, taking up a lot of space, explains Amy Whalen, RN, BSN, SANE-A, the assistant nurse manager in the ED.
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Process improvements typically take center stage whenever hospital administrators decide that patient throughput and patient satisfaction are not where they need to be.
