Emergency Medicine - Adult and Pediatric
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What Is Really BRUEing?
In May 2016, the American Academy of Pediatrics (AAP) published clinical practice guidelines titled Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants, suggesting a new terminology, an evaluation based on the risk of recurrent events or serious underlying causes, and key action statements (management recommendations) for patients meeting the brief resolved unexplained events (BRUE) definition for lower-risk patients. The authors review and discuss the definitions and key management strategies recommended in these new guidelines.
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Can Plaintiff Prove Documented ED Evaluation Never Happened?
Inadvertent checking of items is one of the legal risks of electronic medical records. One common scenario: Someone checks a box stating that the patient’s current medications were reviewed. It turns out the patient was taking a medication that was contraindicated to something that was administered in the ED. This can lead to a "he said/she said" situation.
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Report: Liability Fears of Discharging Low-risk Pulmonary Embolism Patients Unfounded
Various investigators have spent the last several years trying to demonstrate the safety and effectiveness of outpatient care in a community setting.
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Anaphylaxis-related Lawsuits Allege Exposures to Known Triggers
To reduce the likelihood of anaphylaxis-related litigation, researchers recommend additional anaphylaxis education, provision of epinephrine auto injectors or other alternatives to reduce dosing errors, and stronger safeguards to prevent administration of known allergens.
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Procedure-related Complication? Expect Supervising EP to Be Named
Lack of adequate supervision and procedure proficiency are the two most common allegations plaintiffs level in such cases.
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ED Protocols Might Add to Liability Exposure of Low-risk Chest Pain
Researchers set out to understand how EPs determine risk and decide to admit patients with low-risk chest pain. They surveyed dozens of emergency medicine residents and faculty about their perceived risk of various scenarios and an admission decision. Physicians used qualitative terms in ways that are different from how those terms are used in typical conversation. This can lead to miscommunication during shared decision-making processes. Investigators discovered that EPs considered any probability greater than 1% for acute coronary syndrome enough of a risk to warrant admission.
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In Missed Appendicitis Cases, Presentations Are Early, Atypical
The authors of a recent study discovered that a triage chief complaint that was less indicative of appendicitis correlated with a higher rate of missed appendicitis in one pediatric ED. The researchers concluded that their findings suggest the potential impact of anchoring bias by a triage chief complaint when trying to diagnose appendicitis. However, one analyst advises that the results should be interpreted with caution because the study authors did not look for the denominator of chief complaints.
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Analysis of Closed Malpractice Cases Reveals Lost Chances to Avoid Problems
A recent analysis of several dozen closed ED malpractice claims revealed failed opportunities to avert diagnostic errors and bad outcomes. Investigators analyzed 62 claims that closed between 2008 and 2015 at a large malpractice insurer, discovering some common final diagnoses in the cases in which errors were made.
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Subarachnoid Hemorrhage and Intracranial Hemorrhage
Time is of the essence in management of intracranial hemorrhage and subarachnoid hemorrhage. The longer it takes to make the diagnosis and initiate treatment, whether it is surgical intervention or simply aggressive primary stabilization, the greater the risk to the patient regarding both morbidity and mortality.
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Tickborne Illnesses
Blood-feeding ticks can transmit a wide variety of pathogens to people, which can result in significant infection and morbidity. During the past 10 years, the incidence of these diseases has increased rapidly, and the geographical regions where they occur has expanded. Recognizing symptoms that often are nonspecific and initiating appropriate treatment are critical to patient outcomes.