[3 MIN READ]
Malpractice claims related to the chief complaint of chest pain continue to plague clinicians. Foremost among these claims is the allegation of “missed MI,” which has now been expanded to include missed unstable angina as well as missed actual myocardial infarction.
Although the evaluation of the adult with chest pain is fraught with many pitfalls, one of the most glaring yet avoidable errors is the reliance upon “bedside maneuvers” to exclude the diagnosis of coronary etiology.
[6 MIN READ]
An adverse drug event (ADE) is defined as harm experienced by a patient resulting from exposure to a medication. An ADE can be caused by an error or poor care, but it is estimated that about half of ADEs are caused by a medication error; these are known as preventable adverse drug events.
Statistics are staggering; they reveal that ADEs lead to 700,000 ED visits, 100,000 hospitalizations, and between 7,000 and 9,000 deaths every year in the U.S. Even within the “safe” confines of hospital care, about 5% of hospitalized patients experience an ADE.
Opioid analgesic use in the hospital setting is usually safe, but it is also associated with serious ADEs. In this issue, we present a case of an adverse drug event that illustrates many of the features known to contribute to opioid-related ADEs in the hospital. Whether this ADE was preventable, treatable or unavoidable – you be the judge!
[1 MIN READ]
As you start an emergency medicine training program, it can be overwhelming deciding where to start with your coursework.
Here we'll outline our recommendations for both how to approach topic selection, as well as course timing, based on our experience working with the largest healthcare systems in the country over the past twenty years.
[5 MIN READ]
In prior blogs, I reviewed the bare-bones of EMTALA, highlighted recent studies of EMTALA investigations, and summarized recently settled cases of EMTALA violations. In this installment, I outline the requirements of EMTALA as they relate to the role of the on-call physician.
EMTALA was passed to prevent the dumping of “non-paying” patients between hospitals. With the enactment of EMTALA, the dumping problem has diminished. The on-call physician plays a key role in patient management under EMTALA.
The “emergency medical system” depends upon emergency department access, availability of specialist physicians through the on-call roster, hospital bed and staff availability, and a referral system for tertiary or highly specialized care.
[8 MIN READ]
I recently reviewed the bare-bones of what EMTALA is and highlighted recent studies of EMTALA investigations.
In this installment, I have summarized nine recently settled EMTALA cases in which monetary penalties were levied by OIG against the hospital that serve to illustrate the factors responsible for alleged violations.
[5 MIN READ]
EMTALA violations can be a costly lesson for both healthcare providers and organizations. EMTALA is an acronym for the “Emergency Medical Treatment and Labor Act.” This statute was enacted in 1986 for the original purpose of preventing dumping – the practice of refusing service to patients in the emergency department for financial reasons. The final EMTALA statute now extends beyond this initial noble goal and prohibits discrimination against ED patients for any reason.
[2 MIN READ]
The development of tools and resources to guide the busy practitioner in prescription decision-making is a welcome trend in healthcare, particularly when the information is instantly available from valuable sources, including Prescription Drug Monitoring Programs and the patient’s medication history. As outlined recently by Ms. Caldwell on the MEDHOST blog, marrying these resources into the prescription functionality of an EHR is a key component in the effort to combat the opioid crisis.
[3 MIN READ]
The risks we face as acute care practitioners are not static—they evolve over time. Just as we master the approach to a longstanding high-risk problem, a new risky patient presentation rears its head to challenge us. Consider ectopic pregnancy. Now that we routinely obtain pregnancy tests on all women from age 10 to 60 and have access to or skills in ultrasound, the evaluation of possible ectopic pregnancy has become largely an algorithmically routine matter, and errors involving ectopic pregnancy have plummeted as a result.
[9 MIN READ]
I certainly don’t pretend to have the answer to the question of how to eliminate the opioid epidemic. There are legislative, regulatory and policy issues far greater than any one of us, but what can the medical community do? This was the call to action by Stephen Stack, President of the AMA, who also happens to be an emergency physician. Dr. Stack clearly labels this as an epidemic and says we have to do something.
[5 MIN READ]
In a recent blog entitled “The Opioid Crisis: Far From Over,” I reviewed the genesis, magnitude and impact of the opioid crisis in America. Now I will switch gears a bit and look at the trends in the liability of opioid prescribing.
First there’s civil liability, which can and does result in fines and judgment awards. One potential civil liability is overprescribing opioids in quantity and/or frequency over long periods.
