Effective solutions to combat diagnostic error exist today. Why haven't more institutions implemented programs with a focus on diagnostic error reduction?
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[9 MIN READ]
Remember paper T sheets? Your patient has back pain, so you grab a paper T sheet from the anatomical rack, walk into the exam room, get your history, make some circles and slashes, and your history and physical is all but complete by the time you get back to your desk. Write in (remember writing?) some MDM and ‘ba-da-boom’, the chart is done. The focus was on easy documentation and receiving appropriate reimbursement for the care provided.
[6 MIN READ]
The overwhelming majority of malpractice lawsuits in emergency medicine and other acute care venues involve the failure to diagnose. In most cases, these patients are discharged home where the missed diagnosis results in an adverse outcome or death. Fortunately, the patient “bounces back” in some cases, creating another opportunity to make the right diagnosis.
I want to take a collective pause with you for a moment to recognize a very special individual in The Sullivan Group’s world, Dr. Tom Syzek. Tom has decided to step down from his position as TSG’s VP of e-Learning. I hesitate to say retire because Tom has a long list of things that will keep him busy, including swimming across Tampa Bay regularly in support of our veterans, long treks at high altitudes, family activities, and who knows what’s next!
I know that whatever the next chapter is for Tom, he will approach it with the same energy, thoughtfulness, creativity, friendliness and loving spirit that defines him. If you have had the great fortune of working with Tom over the years, you definitely know what I am talking about.
[12 MIN READ]
While the mission of clinical research is to advance the practice of medicine, it is an extremely daunting task to not only manage clinical trials, but to also oversee them to keep patients safe and reduce risk. In a review of numerous malpractice cases related to clinical research, I have found several common denominators and opportunities to improve patient safety.
The issues that arise from clinical trials are not typically intentional; they are simply intrinsic to the complexities of the system. Under the best of circumstances and in many cases by design, patients have significant problems and are randomized to receive a trial drug. This population is inherently at risk. Additionally, many medical professionals are not trained to conduct appropriate, safe, well-organized clinical trials. These factors along with others I will outline have led to an increase in patient injury, federal and legal scrutiny, and obviously, litigation.
In today’s case presentation, we will navigate the difficult waters of patient refusal of life-saving care based upon religious beliefs. In this actual case, a woman’s life hung the balance. There was little time for formal mental status evaluation or communication with legal counsel or a local judge.
It was around 8:30 pm during a busy shift in the Cook County Emergency Department. A young woman had been rolled into the department with low blood pressure.
Intoxication! Talk about a red flag! Let’s consider two “flavors,” if you will. First, the patient with an actual chief complaint AND who happens to be intoxicated. Next, the patient who presents with apparent intoxication and no other immediately obvious issues. And for those of you who have not had a busy shift in an urban emergency department, the number of patients with altered mentation secondary to alcohol can be remarkable. Unfortunately, many of these patients get to be regular visitors; they are well known by the emergency providers and are often on a first-name basis.
If you ask leadership at many hospital organizations to name their highest current quality priority, many will respond that it is sepsis. In recent years, medical researchers have identified that key interventions dramatically alter the course of sepsis. Key factors such as early identification, early administration of antibiotics, and appropriate fluid loading significantly reduce morbidity and mortality. Hospitals and organizations that have followed the evidence have consistently demonstrated significant improvements in patient outcomes.
In general, practitioners don’t appreciate anything that “pops up” or gets in the way of their typical workflow. This aspect of some EMRs can cause dissatisfaction, even anger. A good example is warnings related to medication prescribing. In some programs, drug interactions of any severity and their complications litter the screen with overwhelming frequency. This simply becomes white noise and is soon ignored, sometimes to the peril of the patient as well as the practitioner.
