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A few hours after a chest pain patient was worked up and discharged with a noncardiac diagnosis in a Virginia ED, he was brought back dead on arrival.
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(Editor's note: This is the second article in a two-part series. In the first article, we discussed the decision of the leaders of the EDs at Sacred Heart Medical Center in Eugene, OR, to begin posting their waiting times on the Internet. In this installment, we examine the process they used to make sure the system was running smoothly before they officially started.)
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For the first time in several years, The Joint Commission standards and goals with the lowest compliance rates are not directly related to the delivery of health care.
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In a growing number of states, including Florida, Georgia, Texas and South Carolina, Utah, Arizona, Michigan, Minnesota, and North Carolina, legislation is being introduced to give emergency department (ED) physicians added protections against malpractice lawsuits.
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A 50-year-old female called emergency medical services (EMS) because she is short of breath. She has a recent history of pneumonia and received outpatient treatment. The paramedics arrive and find the patient in moderate respiratory distress. The patient states she wants to be transported to Our Lady of the Financially Secure Hospital (Hospital A) because this is where her health maintenance organization (HMO) is; the estimated time of arrival (ETA) would be 15 minutes.
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Tom Scaletta, MD, medical director of a high-volume community hospital in a Chicago suburb, says that his interest in calling back emergency medicine patients began a decade ago when he created and implemented programs in two high-volume EDs that he directed. "I staffed the position with dedicated clerks who attempted to reach every discharged patient," he says.
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During past medical malpractice crises, many states established "patient compensation funds" to provide accessible and affordable medical liability insurance to health care providers.
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Patients with acute joint pain present a diagnostic dilemma for many emergency physicians. Classically the joints are hot, swollen, and tender, with reduced range of motion. The differential diagnosis for the painful joint is extensive.
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Injuries of the hand and wrist present significant clinical challenges to the trauma practitioner because of the complex structures involved and the possibility of occult disruptions.
