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A common diagnostic dilemma for emergency medicine physicians is the patient who presents with a painful testicle. Frequently, the presentations of the various conditions that cause scrotal pain and most frequently testicular torsion fail to "conform to the accepted clinical picture."
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Margaret Bergin, an attorney with Palumbo Wolfe in Phoenix, AZ, and a former hospital risk manager, says the longer the psychiatric patient is allowed to remain in an ED without mental evaluation, the higher the possibility that the patient will leave against medical advice (AMA).
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If a psychiatric patient harms himself or someone else after being transferred or discharged from your ED, can he or she successfully sue for malpractice? If so, would a jury agree that the ED was at fault? That depends, in large part, on the details contained in the patient's chart.
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Leslie S. Zun, MD, chairman of the department of emergency medicine at Rosalind Franklin University of Medicine and Science in North Chicago, IL, says that if a patient discharged from the ED later commits suicide, "there are a number of issues that can place the emergency physician at risk." Zun gives these five major areas of risk involving ED psychiatric patients:
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A 25-year-old male patient is brought to an ED because of suicidal statements made to his ex-wife. The patient arrives via police escort and is placed in a room. The ED nurse assesses the patient, who denies suicidal ideation or intent. Although the man admits to drinking alcohol, he does not appear to be overtly intoxicated and is coherent. The ED is extremely busy, and the physician assistant (PA) picks up the chart.
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Michigan appeals court allows use of hospital's internal policies and ACEP's Clinical Chest Pain policy as evidence against hospital and urgent care physician in malpractice case.
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Obtaining accurate, detailed information about a patient's insurance coverage is the goal of any registrar, regardless of the patient's point of entry. Clearly, though, emergency department (ED) patients pose some unique challenges.
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As payer requirements become more numerous and stringent, any type of error can result in a needless claims denial.
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The mission of eight onsite Medicaid case managers at WakeMed Health & Hospitals in Raleigh, NC, is to "focus only on patients who have been patients at WakeMed," says Heidi McAfee, director of patient access/case management.
