Blog & Articles

[3 MIN READ]

When most people think of triage, they think of nurses making sense of the chaos caused by 141 million annual visits to the ED.

Patients who are part of this massive onslaught of unscheduled care arrive daily at any hour, and the first person they see is someone in triage, usually a nurse, whose job is to quickly figure out who needs to be seen in what order.

In my early practice years, my ignorant impression was that triage was for dummies – all one had to do was just sit there and assign patients to a room.

Many years of experience and observation have taught me otherwise – that triage is where the best and brightest nurses should be. 

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.

[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.

[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.

[4 MIN READ]

Child physical abuse exists in all corners of the country and affects children of all ages, ethnicities, and socioeconomic groups.

Consider the following facts:

• More than 2 million reports of suspected child maltreatment are investigated each year in the United States. These reported cases represent only a fraction of the abuse that children experience.
• Child maltreatment includes neglect and abuse that may be physical, sexual, emotional, or psychological.
• There are more than 650,000 substantiated cases of child maltreatment annually.
• About 18% of child maltreatment involves physical abuse.
• More than 1,500 children die each year due to abuse or neglect. 80% of these deaths are children under 4 years old.
• The incidence of child abuse is underestimated since 17% of adults in the U.S. report that they were physically abused as a child.

[1 MIN READ]

If your organization is navigating the onboarding and integration process for newly employed physicians, you're not alone.

The Physicians Advocacy Institute recently reported that U.S. hospitals bought 5,000 independent physician practices between July 2015 and July 2016. The percentage of hospital-employed physicians increased by more than 63% from mid-2012 to mid-2016.

TSG's RSQ® Education - Physician Integration Program is designed to put the best practices of patient safety and risk management at the fingertips of your physicians and systematize your ongoing compliance training.

[3 MIN READ]

Headache is a common reason for a visit to practitioners in primary care, urgent care, and emergency medicine. Patients with the chief complaint of non-traumatic headache comprise 3% of all emergency department visits.

The vast majority of these headaches will have a benign etiology such as tension or migraine. Unpredictably interspersed among these benign presentations are patients with a serious cause of headache such as hemorrhage or CNS infection.

Malpractice cases involving headaches frequently involve the missed diagnosis of subarachnoid hemorrhage (SAH). The reasons the diagnosis of SAH is missed include the following:

[4 MIN READ]

Patients with chest pain are a common and constant challenge to clinicians, whether in the office, clinic, urgent care or emergency department. The clinical presentations may be confusing, the differential diagnoses are myriad, and not all patients with chest pain will have a serious underlying etiology.

Lawsuits involving the care of patients with chest pain are frequent and make up the costliest group of malpractice cases in Emergency Medicine. The cornerstone of high-quality, defensible care consists of a systematic approach coupled with comprehensive documentation.