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As the country moves toward full implementation of the Affordable Care Act, one issue that many safety-net hospitals are grappling with for the first time is market competition. While it is still not clear how many states are going to go along with the reform laws expansion of Medicaid, the thinking is that in areas where newly insured patients have options for where to receive care, safety-net facilities are going to have to compete with other facilities to be the hospitals of choice.
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It is entirely understandable for emergency providers to question any new task or responsibility handed down by regulators or administrators. Busy providers are already stressed with burgeoning patient volumes and all the pressures associated with handling acute care crises.
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The face of health care compliance is rapidly changing. Having spent the past week attending the largest health care compliance gathering in the country, I am convinced that no one is immune to payer audits.
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Sometimes just making people aware of their performance is all that is necessary to significantly improve care. Investigators at the University of California at San Francisco (UCSF) found this to be precisely the case when they attempted to use this approach to improve door-to-needle times for stroke patients who presented to the ED for care at UCSF Medical Center.
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With the proliferation of medical devices in recent years, hospital providers are now bombarded with a cacophony of sounds, signals, and other information emanating from these ubiquitous machines.
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The first Dodging the Bullet article was written and published in the September 2011 issue of ED Legal Letter. In the earlier article, as well as this article, a series of actual clinical cases are presented that could have turned out differently if the wrong management decision had been made. The goals of this article remain the same as the earlier one: to glean important points of educational and teaching value from each of the reported high risk cases; and to highlight the fact that clinical misadventures are often a single judgment call away from a potential tragedy.
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Missed acute myocardial infarction (AMI) cases are usually top of mind when it comes to ED malpractice litigation, but other lesser-known clinical pitfalls also result in claims, warns Martin Ogle, MD, FACEP, senior partner and vice president of CEP America, an Emeryville, CA-based provider of acute care management and staffing solutions.
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When researchers at University Hospital Basel in Switzerland set out to study triage of elderly patients in their ED, they were surprised to find that 22.5% were undertriaged, reports Christian Nickel, MD, one of the studys authors and an emergency physician (EP).
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After a few mild seasons, the flu packed a wallop this year, straining resources in hospitals across the country and forcing some EDs to go on diversion during peak periods.
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Since mid-2004, The Joint Commission (TJC) has held all accredited hospitals to task for enforcing use of the Universal Protocol (UP), a practice designed to improve procedural safety by having clinicians go through a three-step process to insure that when they perform a procedure, they are performing the right procedure, on the right patient, in the right place.
