Emergency Medicine - Adult and Pediatric
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Limb Ischemia and Gangrene
Although many cases of extremity pain are the result of mild, self-limited issues, ischemia and gangrene are catastrophic causes of pain that initially can present with nondescript findings. To limit tissue loss and optimize patient outcomes, emergency physicians must be able to distinguish benign limb pain from the earliest stages of high-risk, life- and limb-threatening disease.
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Claims Allege Life-saving Information Was Hiding in Plain Sight
The patient history, labs, and radiology — that was the extent of the information available to EPs historically. EPs argue they do not have time to hunt for every possible piece of information that could have prevented a bad outcome. But that is beside the point when lawyers get involved. Critical information might be hiding in plain sight. Modules used by pathology or radiology are not always easily accessible, but ED providers should not expect a jury to be too sympathetic to this dilemma.
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Poor Nurse-EP Communication Pits Hospital Against EP
Conflicting deposition testimony bolsters any medical malpractice case. Communication gaps between EPs and ED nurses often become a central issue during malpractice litigation. Conflict over what, if anything, nurses communicated to the EP works to the plaintiff’s benefit.
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A Deeper Exploration of How ED Nurses Triage
Triage practices vary widely among emergency nurses and within EDs, according to the authors of a recent study. Researchers conducted focus group interviews with 26 ED nurses. ED nurses reported a pervasiveness of “quick look” triage techniques, which do not rely on physiologic data, to make acuity decisions. Participants described processes that were manipulations of the triage system to “fix” problems in ED flow rather than a standard application of a triage system.
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A Look at How ED Defendants Change Practice Habits After Litigation
One could argue that the threat of malpractice liability improves the quality of care delivered to patients. Data were lacking regarding the connection between litigation and subsequent improved quality of care in the ED. To learn more about this, researchers analyzed data from a national EP group practicing at 61 EDs in 11 states between 2010 and 2015. Learn more about those findings.
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Ignored Red Flags in ED Missed Sepsis Claims
Several recent malpractice cases alleging missed sepsis involved triage in some way. Often, the triage nurse does not recognize early signs of sepsis or identifies early signs of sepsis, but the patient remains in the waiting room because the ED is full. When reviewing ED charts in missed sepsis claims, one expert looks for documentation on who the nurse spoke with, whether the ED nurses notified the charge nurse to discuss which patients could be moved to a lesser care setting, and whether the ED nurse asked the nursing supervisor to assist with the process.
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No Professional Interpreter? ED Exposed to Med/Mal, Statutory Risks
Despite state and federal laws requiring professional interpreters be offered to patients with language barriers, many EDs still rely on family members, friends, or untrained staff. The ED chart should show that an interpreter informed the patient of risks of invasive procedures, the ED provider reviewed discharge instructions with the interpreter, and the patient was informed of risks of ad hoc interpreters.
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Pushback Against EMTALA Misinterpretation Emerges
Misinterpretation of the Emergency Medical Treatment and Labor Act (EMTALA) is the focus of a recently published policy statement from the American College of Emergency Physicians.
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Not All Round Rashes Are Ringworm: A Differential Diagnosis of Annular and Nummular Lesions
Although rashes are not usually an emergency, it is common for emergency physicians to see patients come in with a rash. Sometimes the rash is new onset, and sometimes it has been present for a while and refractory to treatment.
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Pediatric Medication Safety
Our smallest patients are the most vulnerable to medication errors. An awareness of potential vulnerabilities when prescribing in this population is essential. The authors discuss when medication errors are particularly likely, common types of errors, and strategies to minimize the potential for errors.