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Emergency Department Management & Law

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  • Should You Hold Off on Orders for ED Boarders?

    EPs may try to put off intervening on admitted patients waiting for inpatient beds to become available to avoid confusion about what was already done for the patient and what the inpatient care plan is, says William C. Gerard, MD, MMM, FACEP, chairman and professional director of emergency services at Palmetto Health Richland in Columbia, SC.
  • Screening Out of ED? There Are Legal Risks

    Is your ED considering screening out non-critical patients by giving medical screening examinations (MSEs), as required by the Emergency Medical Treatment and Labor Act (EMTALA), then giving patients a choice of seeing a primary care doctor or paying a fee?
  • No System to Respond to Acuity, Volume Surges?

    Lawsuits related to treatment delays in EDs aren't limited to patients in the lobby who are waiting to be seen, says Andrew Garlisi, MD, MPH, MBA, VAQSF, medical director for Geauga County EMS in Chardon, OH.
  • Unmonitored Vital Signs "Disasters Waiting to Happen"

    Many medical conditions aren't possible to diagnose without appropriate cardiorespiratory monitoring, vital sign reassessments, and diagnostic testing, and these are "disasters waiting to happen," warns Andrew Garlisi, MD, MPH, MBA, VAQSF, medical director for Geauga County Emergency Medical Services (EMS) and co-director of University Hospitals Geauga Medical Center's chest pain center in Chardon, OH.
  • The Approach to Penetrating Abdominal Trauma

    Penetrating abdominal trauma (PAT) has the potential to be a devastating injury and ranks in the top 15 causes of death for all ages. This article will define the problem of PAT and review the initial management, including the ability to identify, resuscitate, and initiate treatment in patients with unstable PAT prior to their transfer to the operating room (OR).
  • Unrealistic ED Policies? Lawsuits Will Follow

    If a lawsuit is filed alleging malpractice in your ED, the only thing worse for your defense than not having a policy covering an important subject might be having one but failing to adhere to it.
  • Policy Not Followed? Explain Reason Why

    Ryan R. Domengeaux, JD, vice president of risk management at Schumacher Group in Lafayette, LA, says, "Policies and procedures are not only driven by statutory requirements, they are also necessary to memorialize service expectations."
  • Biggest Legal Risk Is Delayed Treatment, Not Parental Consent

    If a boy is brought to an emergency department after being injured in an all-terrain vehicle (ATV) accident while at a friend's house, do triage nurses wait to get in touch with the parents before treating him?
  • Bad Outcome in Waiting Room? Defense Is Difficult

    Jurors might be able to understand the fact that patients can't always be treated immediately in a busy ED, particularly if a plaintiff didn't have obviously life-threatening symptoms at the time.
  • Don't Invite Lawsuits With Too-specific ED Policies

    An ED's policy may state that reassessments should occur every 30 minutes, or that EKGs should be given within 10 minutes of the patient's arrival, but there will always be circumstances in which these timeframes aren't met.