Emergency
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Sparse Neurology Exam Complicates ED Defense of Missed Stroke
Sparse or inaccurate charting allows plaintiff attorneys to allege inadequate neurological examination in missed stroke cases against EPs. However, documentation that includes a thorough description of all the aspects of the exam, an explanation of why the EP didn’t think stroke was likely, and an indication that the EP consulted a neurologist can help the defense.
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Late Electronic Medical Record Entries Create Indefensible ED Malpractice Claims
Malpractice cases may become indefensible if the forensic IT expert can prove the ED chart was altered in some way. Data regarding physical examination or history can appear self-serving. The veracity of altered information will be questioned. Even if the EP’s motive was valid, it may appear otherwise.
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EPs Face Legal Exposure as ‘Captain of the Ship,’ Even for Triage Mistakes
An EP could be hundreds of feet away when a patient with a life-threatening condition is mistriaged. That doesn’t necessarily stop an affected patient from suing that EP for the resulting adverse outcome.
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Use Simple Strategies to Manage Frequent Interruptions, Minimize Potential for Errors
Research shows that emergency physicians may be interrupted 10-15 times per hour, leading to the potential for errors and patient harm. However, experts note that an array of relatively simple strategies can help clinicians better manage these interruptions to both minimize related mistakes and potentially ease the frustration that results from continuous interruptions.
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Hospital Leverages Pharmacists, Trained Technicians to Reduce Medication History Errors
To reduce the high number of medication errors observed in the medication lists of medically complex patients who are admitted to the hospital from the ED, Cedars-Sinai Medical Center in Los Angeles developed an intervention whereby pharmacists or trained pharmacy technicians review and prepare medication histories rather than rely on usual care for this task.
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ED-based Intervention Connects Frequent Users With Program to Address Underlying Needs
Grady Memorial Hospital in Atlanta established a Chronic Care Clinic (CCC) to take over the care of high-needs patients who frequent the ED. Navigators intervene with these patients when they present to the ED and connect them to the CCC, which offers an array of services to meet several social and medical needs. The goal of the program is to eventually transition these patients to primary care so their underlying needs can be addressed.
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Advanced Cardiac Life Support Updates
The American Heart Association Advanced Cardiac Life Support guidelines are recognized as the authoritative reference for acute cardiopulmonary resuscitation. Emergency medicine providers should be thoroughly familiar with these guidelines.
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Urine Output: The New Vital Sign?
An analysis of a large ICU database showed that hourly monitoring of urine output was associated with improved detection of acute kidney injury (AKI) and lower 30-day mortality in patients with AKI.
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More ICU Care Does Not Equal Better Survival for Elderly Patients
Using a systematic strategy for promoting ICU admission for elderly patients resulted in a higher ICU admission rate but the strategy produced no effect on six-month mortality.
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Implementing Noninvasive Ventilation: If You Build It, They Will Come
Hospitals that have been highly effective in implementing noninvasive ventilation as front-line therapy for acute exacerbation of chronic obstructive pulmonary disease recognized that a combination of allied health autonomy, interdisciplinary teamwork, and devoting sufficient resources are essential features for success.