Anything and everything that improves patient safety is important. The sheer weight of that sentence can be overwhelming to healthcare professionals. Consider one conclusion from the Institute of Medicine (IOM) report “Improving Diagnosis in Healthcare” that states, “Advancing patient safety requires an overarching shift from reactive, piecemeal interventions to a total systems approach to safety in which safety is systematic and is uniformly applied across the total process.”
Many organizations that study medical liability trends often point to breakdowns in communication, cognitive errors, lapse in clinical judgement, etc. as the main contributing factors that cause diagnosis-related claims. Because 60% of Emergency Medicine claims are diagnosis-related, every health care organization should have a strategy for mapping and organizing the most common clinical risk areas that physician’s face. Below we outline a tool that aims to help health systems organize a strategy to address the most frequent and severe malpractice claims.
Whether we like it or not, the future of medicine is geriatrics. As the demographics in the United States change in the next 50 years, it is predicted that practitioners will find themselves providing care to a much larger group of elderly patients. For example, the 2014 census data showed that 14.5% of the U.S. population was 65 years of age or older. By 2040, it is estimated that this age group will grow to comprise 22% of the population. People are actually living long enough to form a subgroup of elderly patients who are over 85 years old – the “super-elderly.” This crowd of the super elderly grew three to four times faster than the general population between 1990 and 2010.
Diagnostic error poses a significant threat to patient safety. According to a 2007-2013 closed claims analysis from The Doctors Company, missed or delayed diagnoses are responsible for 57% of malpractice claims in emergency medicine.
Before we can design patient safety initiatives to address diagnostic error in our organizations, we must first understand the breadth of the issue. This infographic outlines the scope of diagnostic error and breakdowns in the diagnostic process that can lead to error.
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.
Provider perception of a positive hospital safety culture receive the lowest score for questions concerning the presence of non-punitive response to errors, effective handoffs and transitions, and adequate staffing.
These results are detailed by the AHRQ in the “Hospital Survey on Patient Safety Culture 2016 User Comparative Database Report.” The AHRQ has been measuring data on patient safety culture since 2004. Surveys are now available for medical offices, nursing homes, community pharmacies, and surgery centers.
Tom Syzek, MD, FACEP, served as the Chief Risk Officer of a multi-specialty physician group and President of the group’s captive insurance company. In those roles, he was the focal point for the Communication and Resolution Program (CRP); he attributes many prevented lawsuits to an effective communication and resolution strategy. We picked Tom’s brain to understand some key questions that we hear clients ask about Communication & Resolution Programs.
Patients with mental health complaints are visiting emergency departments and urgent care centers at an increasing rate. It is imperative that triage staff are able to make rapid and safe decisions for these patients.
Making assumptions in triage is dangerous. Our subconscious biases can lead to cognitive errors in the assessment of patients, particularly those who are agitated.
Physician workflow frustrations are cited by several studies as a significant contributing factor to physician burnout, an epidemic estimated to impact 51% of the physician population according to Medscape’s 2017 study. Because burnout can be tied to risks in patient safety, improvements in physician workflow are key components in the patient safety movement.
Over the decades, physicians have worked with various medical record documentation styles. While this evolution is thought to improve patient care with each step, the majority of physicians and health systems have yet to maximize the potential of their documentation to improve patient safety. Moreover, each evolution might also be cited as being more complicated and time consuming for the physician, thus adding to their workflow frustrations.
Pain management in the acute care setting (ED, Urgent Care, office) has once again catapulted to the top of the list of hot topics. Years ago the conversation centered on recognizing pain as a “fifth vital sign” and navigating the tricky crossroad of patient satisfaction and the provision of timely, sufficient pain medication. In the Emergency Department, I witnessed every extreme of practitioner and patient behavior.
