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The practice of emergency medicine has evolved significantly since the first 24/7 emergency departments (EDs) opened in the 1950s and 1960s. In the past few decades, EDs have experienced an onslaught of increased patient volumes, increased demand for critical care services, increasing ED lengths of stay (LOS), and increased patient boarding.
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Lawsuits for "loss of chance" involving ED care are increasing, reports Jennifer L'Hommedieu Stankus, MD, JD, a medical-legal consultant, former medical malpractice defense attorney, and a senior emergency medicine resident at the University of New Mexico Health Sciences Center in Albuquerque. "This is a tricky legal concept that is gaining in popularity, particularly for things such as failure to offer [tissue plasminogen activator] to patients with acute ischemic stroke," she says.
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Imagine finding a note in your ED patient's chart from a consultant, which recommends care that you believe is totally inappropriate. Should you quietly seethe, or report it to a higher-up?
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If nursing assessment conflicts with an emergency physician's (EP), the ED nurse should speak privately with the EP about this, advises Mariann Cosby, MPA, MSN, RN, LNCC, principal of MFC Consulting in Sacramento, CA. Document subjective and objective patient data, what was communicated to the EP and other providers, their response, and then the nurses' actions, she recommends.
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As the number of mid-level providers (MLPs) staffing EDs increases, the number of lawsuits involving them is also increasing, reports Jennifer L'Hommedieu Stankus, MD, JD, a medical-legal consultant, former medical malpractice defense attorney, and a senior emergency medicine resident at the University of New Mexico Health Sciences Center in Albuquerque.