Blog & Articles

[5 MIN READ]

In recent years, emergency department providers have regularly faced an expanding volume of patients with mental health needs. Then COVID-19 happened, dramatically taxing the healthcare system and increasing demands on providers while also challenging patients’ mental health across the board. In response, it is essential that ED providers increase their knowledge and comfort with the assessment, treatment, and disposition of mental health patients in order to improve timely care for these patients, many of whom require behavioral healthcare in the ED.

EDs Need Tools and Resources for Assessment and Treatment

Psychiatric and substance abuse issues had already more than doubled prior to COVID-19 disrupting our lives more than doubled, rising from 6% to 15% 1. And while traditional visits to the emergency department decreased during the pandemic, visits requiring care for adult psychiatric and substance abuse issues increased substantially. This often presented as anxiety or depression diagnoses, trauma, and stress-related disorders, and increased substance use. Some of these problems manifested as an increase in suicide ideation and attempts.

Despite almost two decades of attention and study, diagnostic error continues to be a main issue in healthcare, affecting an estimated 12 million people each year and causing harm in one-third of these cases.

The most comprehensive literature on this topic comes from “Improving Diagnosis in Health Care,” in which the first recommendation is to “facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families.” Specifically, it calls for increasing nursing engagement in the diagnostic process; no longer is the diagnostic process the sole purview of a physician. Here we use a case review to demonstrate the importance of nurses in reducing diagnostic error and saving patient lives.

[6 MIN READ]

Any discussion of communication in healthcare must include the process of transferring patients and their vital medical information from one provider to another and/or from one healthcare setting to another.

Such transfers are known as healthcare handoffs.

Examples include when a patient is transferred from an ambulance to an ED or when a surgical patient is moved from the recovery room to a surgical floor.

A person-to-person handoff takes place when, for example, a physician going off duty signs off to the evening on-call doctor or when nurses report to each other at shift changes.

Handoffs are specific circumstances in healthcare that are prone to medical errors.

History

A 25-year-old man presented to the ED with the chief complaint of low back pain. The pain onset gradually about 10 days prior, days after he lifted some furniture. The pain was described as dull and constant, with an intensity of level 7 out of 10 and getting worse in the past few days. He also had milder pain in the mid-back. Nothing seemed to make the pain better, and movement made the pain somewhat worse. He denied any prior back injury or surgery.

It’s estimated that between 3,000 and 8,000 people in the U.S. have Vascular Ehlers-Danlos Syndrome (VEDS), although many are undiagnosed. Because 50% of those with the condition do not have a family history, the road to diagnosis and expert care can be long. Many individuals with VEDS are not diagnosed until they have a life-threatening event, and 80% of VEDS patients will experience a major medical event by age 40; too many are diagnosed during autopsy.

The likelihood of someone coming into the emergency department unaware of their VEDS diagnosis is high, but a VEDS diagnosis can change the approach to a patient’s emergency and surgical care and outcomes. Therefore, it is critical to be familiar with this condition. Here we present a missed diagnosis case and its impact on the invasive interventions.

[8 MIN READ]

Why was the diagnosis really missed?

In my previous position as Manager of Risk, Claims & Insurance for our physician group, the available methods of error analysis never satisfied my quest for the ultimate answer to this recurring question in any given case. The majority of our group practice was emergency medicine; our claims data mirrored the national trends showing that most claims were related to diagnostic error, which contained the allegation that a clinician was negligent by either not making the diagnosis in a timely fashion or failing to make the diagnosis entirely.

[4 MIN READ]

Every day, ED physicians, physician assistants, nurse practitioners and nurses are confronted with pediatric patients suffering from infections. Thankfully, most are self-limited respiratory or gastrointestinal viral infections.

Symptomatic and supportive care may be necessary, but antibiotics are not usually indicated; minor infections such as otitis media, impetigo, pharyngitis and uncomplicated urinary tract infections usually respond well to either oral antibiotics or a single parenteral dose of an antibiotic.

When treating an infant or a child with an infectious process, it is important to check for and recognize the subtle warning signs and symptoms of a more serious infection – whether viral or bacterial. When overlooked in their earliest stages, several types of infections can progress to life- or limb-threatening situations. Failing to consider and test for the possibility of serious infections in children can lead to serious, even fatal, outcomes.

7 minute read

It appeared to be a typical, run-of-the-mill board meeting at Hospital System “X.” Patient admissions had been slowly on the rise; healthcare teams seemed to be handling the increasing demand for services as the hospital facility continued to display an inviting appearance.

Early in the meeting, the hospital CFO presented the data requested by board members; suddenly things took a dramatic turn. Several months of data had revealed that a profit drain had developed within the system. And worse news was that month-to-month figures showed this was not just a temporary “blip” in financial performance, but that it had become a consistent and expanding downward trend. Hospital System “X” still was operating in the black, but not to the satisfaction of the board. They immediately called upon top management to identify the problem areas and propose appropriate solutions.

[3 MIN READ]

The incidence of spinal epidural abscess (SEA) has doubled in the past 2 decades due to the epidemic of MRSA infections, the spread of IV drug use, and the increased number of spinal and vascular access procedures. Delayed or missed diagnosis of SEA leads to profound disability or death; lawsuits in this arena are exceptionally costly.

[3 MIN READ]

Patients with abdominal pain are a common and constant challenge to practitioners in primary care, pediatrics, urgent care, and emergency medicine. During the period of 2006 to 2014, there was a 32% increase in ED visits for the complaint of abdominal pain, so that as of 2014, abdominal pain is the most frequent diagnosis for an ED visit. The clinical presentations may be confusing; the differential diagnoses for abdominal pain are myriad; and not all patients with abdominal pain will have a serious underlying etiology.

Medical errors and litigation involving the care of patients with abdominal pain are all too frequent and can be costly for both patients and physicians. The cornerstone of high-quality, defensible care consists of a systematic approach coupled with compulsive documentation. The essence of liability reduction in the care of patients with abdominal pain is to construct a medical record that provides a thorough, clear and logical explanation for your thoughts and actions. Here are a few key items to address in the chart documentation.