A chief complaint of pain is one of the most common encountered by practitioners in any specialty. The pain may be acute or chronic. It may be located in the abdomen, chest, head or any other body part. It may be spontaneous in onset or may be due to an injury. It can range from minimal discomfort to a 15 on the pain scale of 1 to 10. The seriousness of the pain may vary from life-threatening to embarrassingly minor.The patient’s description of pain may be pinpointed and exact or agonizingly vague. Regardless of its characteristics, pain is what brings patients to healthcare providers by the millions every year.

It should be no mystery to anyone that EDs see more than their share of fireworks injuries on July 4th and hangovers on New Year’s Day. But what about on Halloween? Will there be a deluge of patients with candy overdoses? Since I couldn’t recall any specific cases from my own Halloween emergency department shifts, I did a casual search and found a few interesting trends.

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” -- President George W. Bush, State of the Union Address, January 20, 2004

The move towards the electronic health record (EHR) has been under way for more than a decade now. Hospital administrators, healthcare insurers, IT vendors and government officials are touting the benefits of transitioning from paper to electronic records.

Many diagnostic errors involve some degree of cognitive bias or errors; here is an actual case that illustrates this point.

Case Presentation

L.B. is a 46-year-old man with onset of illness 12 days prior that started with cold symptoms, sore throat, rhinorrhea, cough, and fever up to 100.7°F (38.1°C). Since then, he has been getting progressively weaker, to the point that he could not walk to the EMS vehicle.

There have been some interesting, and some frightening, developments in case law relating to healthcare risk management since the last annual meeting of the American Society for Healthcare Risk Management (ASHRM). While these cases may not have national importance (yet), they have concerning implications for healthcare.

Physician engagement is sometimes cited by organizations as a challenge on its path to implementing a successful practice change initiative.

Below are five tips for engaging physicians using continuing medical education (CME):

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.

Malpractice claims continue to plague the specialty of Obstetrics. In the 2015 ACOG Survey on Professional Liability, a total of 4,294 physicians responded; 73.6% had at least one claim filed against them during their careers. There were 1,117 total claims reported by the surveyed OB-GYN physicians, with 63.5% of these claims involving obstetric care, and the remaining 36.5% involving gynecological care.

Triage is an essential part of any busy emergency department (ED), but one that is often taken for granted. While triage is not designed to determine the cause of the patient’s symptoms, it prioritizes the patient’s need to be seen by a provider. EDs often assume (possibly erroneously) that triage assessments are being performed correctly or that any errors in triage can be corrected when the medical screening is done. Both of these assumptions can lead to serious adverse patient events.