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By simplest definition, shock is a state of inadequate substrate delivery at the cellular level.
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Every trial usually comes down to a "battle of the experts," with the jury judging the credibility of the experts and making their decision. Consider these important factors, advises Linda M. Stimmel, a partner with the Dallas, TX-based law firm of Stewart Stimmel: Experience, education, training, the effectiveness of how the expert communicates with the jurors, and the bedside manner of the expert. "Even how the expert is dressed may affect their credibility."
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We should all be aware of the four components of malpractice the physician had a duty, breached the duty, there was harm to the patient, and the harm was caused by the breach of duty.
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Historically, emergency department (ED) triage was rarely a high-risk issue for hospitals, primarily because short waiting times resulted in all patients being seen quickly by the emergency physicians. Today, the combination of overcrowding, markedly prolonged waiting times, increasing numbers of patients leaving the ED before examination, the nursing shortage, diminishing financial support, and federal Emergency Medical Treatment and Active Labor Act (EMTALA) mandates make triage a very dangerous encounter for the patient and a fertile source of litigation against providers.
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The credibility of "dueling experts" testifying before a jury often determines the outcome of a lawsuit alleging malpractice by an emergency physician, but in fact, expert witnesses typically get involved weeks before a case is even filed.
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This is the second of a two-part series on delayed diagnoses in the ED. This month, we report on legal risks involving time-dependent medications and interventions.
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Most managers have been pushing extra hard to improve safety over the last few years, and The Joint Commission says all the hard work is paying off.
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In the latest move in the continuing saga of the National Patient Safety Goal (NPSG) on medication reconciliation, The Joint Commission has said while it will continue to evaluate compliance with the standard during on-site surveys, "it will not be factored into the organization's accreditation decision and will not generate Requirements for Improvement [RF])." The new policy, announced recently, became effective retroactively to Jan. 1, 2009.
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A new program in Houston that involves tight teamwork between The University of Texas Medical School at Houston, the Memorial Hermann Heart and Vascular Institute Texas Medical Center, and the Houston Fire Department EMS, as well as an experimental "cocktail" given in the ambulance to patients meeting certain criteria, has dramatically reduced Percutaneous Coronary Intervention (PCI)-to-balloon time and improved survival rates.
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The senior emergency center at Holy Cross Hospital in Silver Spring, MD, may be a rarity, but based on the responses of patients and staff not to mention our increasingly aging population perhaps more EDs should consider creating a separate unit for older patients.
