Emergency Publication
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EMTALA Implications if ED Patient Needs Medically Necessary Abortion
It is a mistake for ED providers to be solely focused on what their state abortion law says, without also considering the bigger picture in terms of other legal risks and ethical obligations.
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Should EDs Offer Contraceptives, Related Family Planning Education?
With many states implementing or planning to implement stringent new restrictions on access to abortion, some clinicians are urging their colleagues to take strong steps to ensure the contraceptive needs of women are met.
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The Joint Commission Puts Providers on Notice Regarding Diagnostic Overshadowing
When patients present with existing diagnoses or disabilities, clinicians might attribute any symptoms to the existing condition. This is called diagnostic overshadowing, a type of cognitive bias that can cause unnecessary suffering, unsafe care, and adverse events related to missed or delayed diagnoses. Unfortunately, the problem occurs more often among groups already experiencing healthcare disparities.
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Legal Risks if Psychiatric History Clouds Medical Decision-Making
Patients with these life-threatening medical conditions may report mood swings, personality changes, irritability or aggression, depressed mood, anxiety, or trouble concentrating. If appropriate history, physical exam, and diagnostic testing are not completed, medical emergencies can be missed. This is particularly common if physical exam findings are subtle.
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Work on Improving the Care of Children with Medical Complexity
Emergency physicians identified significant challenges in providing high-quality emergency care to these patients. These include time constraints, the need to adequately review the expansive medical record for key information, and the need to contact known physicians when making treatment and disposition decisions. Respondents indicated communication with known providers and use of emergency information forms summarizing the child’s medical history were helpful.
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Med/Mal Concerns if ‘Float’ Nurses Cover the Department
Of 2,575 nurses from 50 states and Washington, DC, 26.5% reported they were “floated” or reassigned to a clinical care area that required new skills or that was outside their competency, according to a survey. Almost half reported receiving no education or preparation before they were assigned to the new unit.
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EDs Need Process for Incidental Radiology Findings
To lower the risks of “failure to notify” claims, institute clear protocols on who is responsible for dealing with abnormal test results. Educate patients on how to find out about their test results; this includes obtaining updated contact information. Finally, use electronic alerts to notify patients and providers when tests results are ready.
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Identifying Pediatric Cervical Spine Injuries
Cervical trauma in pediatrics is fortunately uncommon, but associated with significant morbidity. Early recognition and timely management are essential to optimize the child's outcome. Balanced against this is the need to minimize unnecessary radiation in young children. The authors comprehensively review identifying pediatric cervical spine injuries.
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The Case for a Team Approach to Manage Agitated Patients
While many EDs have instituted mechanisms to quickly trigger security staff, a Connecticut hospital created a unique team-based protocol that includes security and clinicians. Everyone works together to protect staff and prevent the need for restraints, sedatives, or other potentially harmful interventions. After three years, staff report they feel safer, and new data show the approach is associated with a lower rate of physical restraint use.
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Remain Vigilant for Signs of Monkeypox
Emergency clinicians should include the possibility of monkeypox in any patient presenting with early symptoms suggestive of the illness and certainly for those with a new rash and epidemiological risk factors.