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[Editor's note: This is the second of a two-part series on medical screening examinations (MSEs) performed by emergency nurses. This month, we cover the potential liability risks of nurse-performed MSEs and how to avoid legal problems. Last month, we reported on benefits seen by two EDs that have implemented this practice.]
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When 103 ED patients, 34 ED physicians, and 44 ED nurses were surveyed, they all agreed on one thing: Treating chronic pain in the ED is a "low priority."
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Nearly half of older patients use prescription and over-the-counter (OTC) medications together, says a new study, and one in 25 is at risk for a major potential drug-drug interaction. The researchers also found that 29% of these patients use at least five prescription medications.
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Severely dehydrated children are "in imminent danger" due to cardiovascular collapse, increased acidosis, and metabolic abnormalities, all of which can lead to significant morbidity and in some cases mortality, warns P. Jamil Madati, MD, director of emergency medical services at Rady Children's Hospital in San Diego.
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Knee and ankle injuries are very common in pediatrics. Sports and recreational activities are frequent sources of injury, hence are sources of typical emergency department (ED) visits. Although sprains and contusions frequently occur, it is critical that the unique aspects of the pediatric skeleton and its associated vulnerability are considered. Imaging and treatment are focused on identification of fractures and associated injuries; correct immobilization and appropriate follow-up, based on the injury, are necessary to maximize the outcome for each injury.
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Belligerent behavior, communication problems, inconsistent responses to questions, and lack of competency to refuse treatment: Any of these factors can get in the way of obtaining a good history and physical for a patient with psychiatric complaints, according to Barbara E. Person, an attorney with Omaha, NE-based Baird Holm.
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There is a growing trend of specialty organizations coming out with guidelines and recommendations, but in some cases, these are inappropriate for ED patientsand may even be harmful.
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Hospital emergency departments (EDs) interact with police on a daily basis with varying degrees of cooperation, but whether the cooperation is good or bad, many police interactions raise risks of violating federal EMTALA and other regulations.
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An emergency physician (EP) diagnoses pneumonia in a 40-year-old male and treats appropriately. Later, the radiologist agrees with the pneumonia diagnosis, but suggests that "a small nodule in the left upper lobe should be evaluated with a chest CT." Somehow, that report never gets read by the ED staff, and the patient's cancer progresses until it is too late for effective treatment. A lawsuit is filed.
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While the introduction of new technologies such as computerized physician order entry (CPOE) were lauded by proponents as "silver bullets" that dramatically would improve patient safety, The Joint Commission is warning in a new Sentinel Event Alert that "users must be mindful of the safety risks and preventable adverse events that these implementations can create or perpetuate."
