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Some EDs have adopted the practice of documenting overcrowding, either
by flagging patient charts or electronically recording the
information with software, to pinpoint exactly how busy—and
possibly, how understaffed—the department was on a given time
and day. But is this going to help or hurt the ED physician in the
event of a malpractice lawsuit?
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Jason Rinehart presented to the emergency department (ED) of Akron General Medical Center with nausea, vomiting, and back pain.1 No definitive diagnosis was made, and the patient was discharged with medications to control his symptoms. He died hours after discharge, and an autopsy revealed an aortic dissection as the cause of death.
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Being served with papers indicating a patient has sued you is a
shocking and upsetting moment. However, this doesn't necessarily mean
the case is valid—or even that it will go forward at all.
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Telemedicine has long been recognized for improving access to care as well as access to specialist expertise, particularly in rural facilities. Now, in an unpublished study just completed in Rochester, NY, the lead author says it also can offer a possible solution to overcrowding when it comes to pediatric ED patients, many of whom, he asserts, easily could be treated by a primary care physician.
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Imagine a new disease strikes your community that significantly increases mortality rates, particularly in critically ill patients. This same disease causes patients to suffer more pain, greater heart damage from a myocardial infarction, and, if they are elderly, increases the chance they will be discharged to a nursing home. Such a disease clearly would grab the public's attention, and even in these difficult times, money would be diverted to find a cure. This problem exists today in many of our communities: crowding.
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Recently, we published a series of articles on the international traveler in the ED, emphasizing the risk factors and geography. This article provides a more standard review of some of the diseases seen in travelers to tropical areas and also some, like West Nile, that have migrated into temperate climates. This article will complete our series.
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Trauma to the pelvis is a great example of how an entity in trauma has undergone major evolutionary changes. Despite advances, the treatment of pelvic trauma continues to pose difficult challenges, and, thus, it continues to be a widely studied topic.
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The purpose of this article is to review the complicated issues of end-of-life and futile medical care as applicable to the emergency department (ED). It will address sources of conflict and confusion, and will conclude with a practical discussion of how emergency physicians can best navigate these complex waters by practical case review.
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In this randomized, double-blind study, 256 patients with submassive pulmonary embolism (PE) were treated with either heparin or heparin plus alteplase, a thrombolytic agent.
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Intensive care is part of a continuum of progressive patient care, and a significant number of research groups are now focusing their attention on ways to improve the organization of the ICU and its place in the continuum of care. An important aspect of this process is the evaluation of ICU discharge policies and their consequences.
