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In a continuing effort to ease demand on busy EDs, some communities are coming up with new ways to leverage paramedics.
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"If the EP had only told me, I would have come right in and admitted the patient," is what a consultant is almost certain to claim if named in a lawsuit resulting from a bad outcome that occurred after a patient was discharged from the ED.
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Two years ago, a Texas court, in the case of Dr. Zawislak v. Memorial Hermann Hospital, determined that emergency physicians were "employees" of the hospital for determining whether they could sue the hospital under the Emergency Medical Treatment and Labor Act's (EMTALA) whistleblower provision for retaliatory termination (see the February 2012 ED Legal Letter).
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An inebriated frequent emergency department (ED) patient, discharged after a cursory examination and no treatment, was found dead in the hospital's parking lot a few hours later.
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Failure to obtain specialist consultation is one of the main recurring themes Ken Zafren, MD, FAAEM, FACEP, has seen over the years in reviewing medical malpractice claims against emergency physicians (EPs) as an expert witness.
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Diabetic patients who lack access to primary care tend to frequent the ED, often with complications from their disease that could have been prevented with proper management and education.
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Hospital and ED administrators have found that initiating patient contact shortly after discharge from the ED can positively impact patient satisfaction while also offering opportunities to improve patient compliance with care instructions and to intervene early if complications arise. While some hospitals still rely on manual calls to patients, others are initiating contact through email and text messages.
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To manage a big spike in demand from patients seeking emergency care for mental health (MH) and addiction medicine concerns, staff from the University of Pittsburgh Medical Center-Mercy and Western Psychiatric Institute and Clinic of UPMC have devised a series of interventions aimed at quickly linking these patients with the care and resources they need.
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In recent years, intensive care units (ICUs) have made considerable progress in eliminating central line-associated bloodstream infections (CLABSIs); however, there is still ample room for improvement on infection-control practices in other settings like the ED, where high volumes, patient acuity, crowding, and other factors can interfere with infection-control practices.
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Some EDs are noticing unexpected decreases in volume that began in the latter half of 2013. The impact has been particularly evident in the Midwest and Northeast, where there has been record cold weather, but observers are concerned that other factors could be playing a role as well.
