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The evaluation of a febrile child is an extremely common scenario in most emergency departments. Emergency physicians must decide which children require a work-up, the nature of that work-up, and the need for antibiotics with or without hospitalization. This process often is in the context of evaluating many febrile children, with only subtle clues as to which child truly may be ill. Unfortunately, it is common for inadvertent errors in judgment to end up in the courtroom as a subject of malpractice lawsuits. This months issue focuses on some of the risks and controversies in the evaluation of the febrile child.
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As of Jan. 1, hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations must meet a new standard that has a higher requirement for care given to admitted patients in the ED, and CEOs will depend on ED managers to lead the effort in complying with this standard.
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The newly announced national patient safety goals, which are expected to receive special emphasis at accreditation surveys, require EDs and other departments of the hospital to accurately and completely reconcile medications across the continuum of care.
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A series of 27 lawsuits aimed at organizations controlling about 250 nonprofit hospitals in 15 states and the Chicago-based American Hospital Association (AHA) have shone the spotlight on the Emergency Medical Treatment and Labor Act (EMTALA) and its requirements concerning the treatment and admission of uninsured and underinsured patients.
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There was a long history of frustration over lab specimen turnaround time but not anymore. Thanks to a successful Six Sigma initiative, turnaround time for the EDs criteria draws (draws based on specific patient criteria that indicate lab work will be needed) has dropped from about 46 minutes to 16 minutes.
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A large number of emergency medicine observers agree that the inability to fully staff ED call panels has reached a critical point.
Why has the problem become so serious?
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If youre having difficulty staffing your call panel, there are two options: You can institute a new approach internally, or contract with a company such as Emergency and Acute Care Medical Corp. (EA) in Rancho Santa Fe, CA, a management services organization with an independently contracted medical group providing call panel and stipend solutions and programs.
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The annual impact of influenza on the United States is staggering: 10% to 20% of the population will get the flu. Some 36,000 people will die, and 114,000 will be hospitalized.
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Headache is a common chief complaint encountered by emergency physicians (EPs). It may be a symptom of benign diseases such as migraine headaches or a common virus. Unfortunately, it also may represent other, more life-threatening illnesses, including subarachnoid hemorrhage. Delineating which patients need radiologic imaging, spinal fluid testing, and even angiography is part of the challenge encountered by the EP. This issue will outline strategies for reducing risk in the headache patient. Specifically, diagnosis and management of subarachniod hemorrhage will be detailed.
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Documentation requirements for every patient encounter have increased, leaving less time for the actual practice of medicine. While documentation is a burden to physicians and nurses, it does have unlimited value. Documentation allows for appropriate billing for the time and efforts of the physician, nurse, and other medical specialists. Thorough documentation allows for maximum reimbursement without fear of subsequent legal retribution from various government programs. Furthermore, the medical record is an essential historical document of the patients previous medical encounters. Documentation of the patient encounter and treatment will provide a defense to potential subsequent litigation that may ensue. The emergency physician may be unaware that a medical expert is reading a case of a previous patient encounter right now. The documentation of the care provided may preclude the plaintiffs expert from making assumptions and opinions adverse to the physician. This months issue will detail the importance of documentation and outline strategies for reducing risk.
