Emergency Department Management & Law
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Charting a Better Way Forward in Addressing Diagnostic Errors
Preventing diagnostic errors has proven difficult. Many of these errors are captured through passive reporting, and systems are not in place to help clinicians learn from such errors. Using active surveillance could uncover more errors, bring those to the attention of clinicians, and provide a teaching moment (not a punishment moment) to prevent those errors from repeating. -
HHS Expands Mental Health Services Access for Young Patients
Agency designates funding for existing program that promotes behavioral health integration into pediatric primary care using telehealth. -
Poor Agreement Between ED Patients and Physicians on Goals of Care
Ideally, goals of care discussions do not happen for the first time when the patient presents to the ED. When goals of care conversations are held earlier in a patient’s disease course, advance care planning is possible. This can alleviate the use of aggressive interventions in the event the patient decompensates or does not make a meaningful recovery.
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Problems When Calling Patient a ‘Drug Seeker’
Is this drug-seeking label truly needed to complete the chart? What message are you trying to convey, and to whom? Who is going to read that chart once you close it, and why?
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Hospitals Could Face Legal Exposure if EPs Are Not Board-Certified
In 2005, there were about 22,000 emergency medicine board-certified emergency physicians in the United States. However, investigators estimated 40,030 emergency physicians would be needed to staff all 4,828 EDs. For years, there was not much additional research in this area. Recently, a group of investigators decided to conduct another analysis and update the data.
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Medication History Often Inaccurate on Inpatient Side
Medication histories were more accurate when obtained by pharmacy technicians, according to a recent study. Of 183 patients admitted through the ED in 2017 and 2018, medication histories were accurate just 38% of the time with the usual process (typically, a nurse reviews the medication list and updates it accordingly) and 70% of the time with pharmacy technicians.
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Most Sickle Cell Disease Patients Avoid EDs During Pain Attacks
In many EDs, sickle cell pain episodes continue to be managed poorly. Sixty percent of patients with sickle cell disease say they “very much” or “quite a bit” avoid going to the ED during a pain attack because of a previous bad experience. Many reported experiencing stigma because of providers’ suspicions of drug-seeking behavior. Half said they waited at least two hours for treatment.
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Checkbox Charting Is Problem for ED Malpractice Defense
Make sure the ED uses modified templates to allow clinicians to add free-form text. Carefully review the record for accuracy before signing the note (including automatically populated checkboxes), either contemporaneously or close in time to the encounter. Finally, maintain a strong compliance program with regular medical record audits, including a review of electronic health record systems.
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Expert Panel Is Low-Cost Way to Determine Strength of Med/Mal Claim
If the panel finds the emergency physician deviated from the standard of care, a malpractice lawsuit is likely. On the other hand, if the panel finds the ED care was reasonable, there is a fair chance the claimant will not file suit.
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Most ED Malpractice Lawsuits Are Dropped, Withdrawn, or Dismissed
When an emergency physician is sued for malpractice, many immediately envision testifying in court before a jury. In reality, few ED claims (7.6%) make it that far. Most cases (65%) actually end up dropped, dismissed, or withdrawn, according to a recent analysis.