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All of the discussion in recent years about the risks from exposure to radiation from computed tomography (CT) scans has hardly dampened enthusiasm for the technology in the ED. To the contrary, a new study suggests that CT use in the ED increased by a whopping 330% between 1996 and 2007, according to a retrospective look at data from the National Hospital Ambulatory Medical Care Survey, which is a national survey of services in emergency departments conducted by the Centers for Disease Control in Atlanta, GA. However, the study also suggests that the increase in CT use may be associated with a dramatic reduction in hospitalizations.
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There is no question that hospitals face innumerable challenges in meeting the "meaningful use" of health information technology (HIT) criteria established by the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009.
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Five years after the Centers for Disease Control (CDC) in Atlanta issued recommendations calling for all health care settings to routinely screen patients for HIV in areas where HIV prevalence is at 0.1% or higher, the practice has failed to take hold in most EDs, even though many obstacles to testing, such as burdensome informed consent requirements, for example, have been cleared away.
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The potential for violence in the ED is well-recognized and often discussed. Several organizations such as The National Institute for Occupational Safety and Health at the Centers for Disease Control in Atlanta, GA, for example, cite the ED as being one of the most dangerous places in health care to work, and a study completed last year by the Des Plaines, IL-based Emergency Nurses Association noted that every week, between 8% and 13% of ED nurses experience some type of physical violence in the course of doing their jobs.
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Quality measures from the Centers for Medicare & Medicaid Services (CMS) and other groups are putting EPs "in a huge bind," according to Sandra Schneider, MD, professor of emergency medicine at University of Rochester (NY) Medical Center.
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If there is absolutely no credible reason to think that a patient's symptoms are due to a heart attack, says John Burton, MD, chair of the Department of Emergency Medicine at Carilion Clinic in Roanoke, VA, you shouldn't be ordering tests such as cardiac enzymes.
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In this article, we present a series of actual clinical scenarios that could have turned out differently if the wrong management decision had been made.
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This is the first of a two-part series on liability risks involving ordering of diagnostic tests in the ED. This month, we'll cover the legal ramifications of deciding not to order a test, the legal risks of unexpectedly abnormal results, how ED protocols can help an EP's defense, and a new quality measure that increases liability risks for EPs.
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If you don't believe a diagnostic test is truly necessary but you order it anyway, you must be prepared for results to come back unexpectedly abnormal, even if these "incedentalomas" have nothing to do with what brought the patient to the ED, warns Bruce Janiak, MD, professor of emergency medicine at Medical College of Georgia in Augusta.
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Imagine a plaintiff's lawyer poring over stacks of documents provided by the defense as a result of a lawsuit alleging ED malpractice, and finding the statement, "This nurse will eventually kill a patient."
