Blog & Articles

The case presentation will be a little different than our typical failure to diagnose an aortic disaster or other common “failure to diagnose” entity in emergency medicine. Although those are great teaching cases, there is another critically important side to the patient safety coin. It is critical to do the appropriate testing to identify potentially fatal presentations, but it is equally important to understand when such testing is inappropriate − testing that itself may by unnecessary and may actually cause morbidity.

Most physicians are aware that there is a duty to provide reasonable care in the patient-physician relationship. Typically, malpractice liability does not extend to anyone outside of that relationship. However, there are certain extraordinary circumstances in which a physician may have an obligation to a third party, one that is outside the patient-physician relationship.

In this case, we present an incredible day-by-day progression from the moment of onset of a vertebral artery dissection as told by the emergency physician
who had it!

Vertebrobasilar artery thrombosis or dissection affecting the posterior circulation can be extraordinarily difficult to diagnose. In the failure to diagnose specialties such as
primary care, internal medicine, family practice, emergency medicine and urgent care where the door is open to all, risk and safety education and evaluation focused around this deadly high-risk clinical entity is critical.

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Sepsis is a regular visitor in the news as cases of flesh-eating bacteria and the dramatic speed with which victims deteriorate hit the headlines. The failure to diagnose sepsis remains a critical issue as delays in diagnosis significantly increase morbidity and mortality.The entire emergency department, urgent care and primary care teams must be focused on early recognition and intervention. This has never been so important as today since evidence now points to interventions that can truly save lives.

A Promise Unfulfilled

What exactly was the promise of the electronic medical record? The tool that was supposed to make life easier, workflow faster, quality of care better, and patients’ lives healthier has pretty much turned into a face-plant; a promise unfulfilled. Although there are some notable exceptions, the market has shifted to the large electronic health record companies, and medical record content and speed and quality are not their highest priority.

Failure to diagnose is the most common medical error in the practice of emergency, urgent care and primary care medicine. Spinal epidural abscess (SEA) is one of the most difficult conditions to diagnose, but there are common threads among failure to diagnose spinal epidural abscess cases. This case is presented to provide perspective and to increase our vigilance for catching this disabling and possibly even fatal diagnosis.

A 35-year-old female presents at 0321 by ambulance with a complaint of chest pain. The records show EMS arriving at her house and finding the patient on the couch.

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EMT Notes

Patient appears to be anxious and hyperventilating.

There is a new risk and safety issue in the world of appendicitis. In this issue of TSG Quarterly, we explore the issue of conservative, antibiotic-first management of acute appendicitis with appendectomy reserved for treatment failures. Is it the new standard? Have you proactively addressed this issue with your emergency medicine and surgical practitioners? It is important to get out in front of this issue to keep our patients safe!

The following case is from an online CME course by Dan Sullivan, MD, JD, FACEP. The course, Batch Events - Catastrophic System Risk, explores the question:

What is a batch medical incident or batch claim and why read a course on this subject?

 Batch medical incident is a term coined by the insurance industry to recognize and manage a certain type of legal claim. 

In pursuit of our mission to improve patient safety and reduce risk, The Sullivan Group (TSG) held our semi-annual gathering of the Risk, Safety, and Quality (RSQ™) Collaborative in mid-November. The RSQ Collaborative, formed in 2010, is an elite group of nationally and internationally recognized clinical champions that share TSG’s passion for reducing medical risk, the frequency of medical errors, and ultimately saving patient’s lives.