World Breastfeeding Month gives us an opportunity to highlight the benefits of breastfeeding as a life-saving infant feeding practice. In support of the importance of breastfeeding exclusivity and skin-to-skin (STS) for the reduction of infant morbidity and mortality, Bill Gates recently wrote, “Some of the best breakthrough ideas don’t involve technology at all. There is a solution that is readily available, requires no special equipment, and is so cheap any government can support it.”
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How do you determine who is actually competent to triage? If you do have a competency assessment plan, is it documented in writing? How do you know it is effective? Is it up to date?
These and many other questions arise when exploring the development and documentation of a triage competency validation process. Answers to these questions are imperative, as they not only impact litigation that may arise, but are also essential for ensuring the highest quality patient care.
Medical errors related to vascular emergencies are common and costly. From head to toe, the vascular system is a fertile field for risk and error waiting to entangle the unwary practitioner.
- Starting at the top, the high-risk vascular entities include a trio of hemorrhages (subarachnoid, subdural, and epidural) and the ischemic duo of TIA and stroke.
- In the chest reside some of the big hitters – acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection.
- Moving south into the abdomen, we find abdominal aortic aneurysm, mesenteric ischemia, GI bleeds, retroperitoneal bleeds and traumatic hemorrhages.
Every day in the practice of medicine, hundreds of thousands of urine samples are tested. The maxim that states “all females between ages 10 and 60 with abdominal pain must have a urine pregnancy test” has been ingrained into our cerebral cortexes. Since the times of ancient medicine, the urinalysis has been used to screen for a host of diseases. The urinalysis is a vital tool in evaluating patients. However, as helpful as it is, it has also led many clinicians down the wrong path towards chaos. Two different cognitive medical errors come to mind when interpreting the urinalysis.
Regulations, rules, litigation, and medical errors are not the most popular topics for the busy clinician. Most of us would rather gargle nuclear waste than spend a precious evening reading about these issues that plague the pure and honorable practice of medicine. However, we avoid such matters at the peril of our patients’ safety as well as our own personal and professional well-being.
Since few (if any) of us will invest in a treatise the length of War and Peace on the subject, I have assembled the following short list of “10 Medical-Legal Basics Every Provider Must Know” for the busy physician, nurse, and advanced practice clinician.
The words are bone-chilling. Nothing can describe being witness to it. Such an event encompasses the ultimate emotional spectrum – the highest of highs at the time of the newborn’s birth to the lowest of lows as the mother succumbs to maternal emergency. The lasting impact of watching a new father and family members exit the hospital OB unit or ICU to head home with a new infant in tow with conspicuous absence of the child’s mother creates palpable heartache. The emotional ripple-effect impacts friends, family, and medical staff for years to come.
Recent studies demonstrate that about 10% of all emergency department patients present with psychiatric illness. Because of the unique risks associated with psychiatric patients, coordinating their care and admission has proven to be a challenge for emergency physicians. Here we present a case that highlights the risks of boarding patients in the emergency department.
A 25-year-old male presents to an emergency department at his local community hospital with abdominal pain. The department is at its peak time of patient flow, and every bed is filled. The patient is called to the triage area; the nurse assesses him and assigns a triage level decision to his chart. His triage nurse must consider the following:
- Is his abdominal pain a potential for demise?
- How long will he wait to be seen by a provider?
- Is there anything that can be done to expedite his care?
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 recurrent 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 “diagnosis-related,” 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.
Once you have allocated resources toward your performance improvement initiative, the next best practice in initiative implementation involves getting your clinicians to support it.
Engaging clinicians early in any initiative is crucial to success. If they decide against participating in the program, morale can suffer. Conversely, clinicians who embrace the program have testified to its worth in improving their practice, saving patient lives and enhancing morale.