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Procedural sedation and analgesia (PSA) has been provided to children in the emergency department for decades. When patients are evaluated properly, and adequate equipment, personnel, and medications are utilized, effective and safe PSA is delivered by the emergency physician, whether in a university or community setting, over a wide range of ages, and with a broad selection of medications.
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The practice of emergency medicine has evolved significantly since the first 24/7 emergency departments (EDs) opened in the 1950s and 1960s. In the past few decades, EDs have experienced an onslaught of increased patient volumes, increased demand for critical care services, increasing ED lengths of stay (LOS), and increased patient boarding.
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The number of lawsuits involving mid-level providers (MLPs) in the ED "seems to have skyrocketed in the last few years," according to Michael Blaivas, MD, FACEP, FAIUM, professor of emergency medicine at Northside Hospital Forsyth in Cumming, GA. "There are multiple scenarios that result in successful suits, and there is a common theme among them."
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Have you ever made an honest mistake that a family member caught before you did, or given the wrong dose of a medication? "These scenarios, unfortunately, can make the news, and they make us look careless," says Michelle Myers Glower, RN, MSN, LNC, a health care consultant based in Grand Rapids, MI. "But how we handle them can make or break us."
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What if the emergency physician (EP) strongly believes a patient needs to be admitted, but a consultant gives a recommendation over the phone to discharge the patient?
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A patient treated and discharged for pneumonia several times at an ED is later diagnosed with acquired immunodeficiency syndrome (AIDS). Could the ED be successfully sued for failing to test for human immunodeficiency virus?
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As the number of mid-level providers (MLPs) staffing EDs increases, the number of lawsuits involving them is also increasing, reports Jennifer L'Hommedieu Stankus, MD, JD, a medical-legal consultant, former medical malpractice defense attorney, and a senior emergency medicine resident at the University of New Mexico Health Sciences Center in Albuquerque.
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If nursing assessment conflicts with an emergency physician's (EP), the ED nurse should speak privately with the EP about this, advises Mariann Cosby, MPA, MSN, RN, LNCC, principal of MFC Consulting in Sacramento, CA. Document subjective and objective patient data, what was communicated to the EP and other providers, their response, and then the nurses' actions, she recommends.
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Imagine finding a note in your ED patient's chart from a consultant, which recommends care that you believe is totally inappropriate. Should you quietly seethe, or report it to a higher-up?
