Obtaining the informed consent of the patient is required in all states before an invasive procedure that carries a material risk of harm is performed. This is a non-delegable duty of the practitioner who is going to perform the procedure; this means that the practitioner is ultimately responsible for the validity of the consent and cannot avoid liability by claiming that it was someone else’s responsibility.
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Because every patient entering the emergency department needs to be triaged, it is imperative to ensure that every triage nurse maintains accurate clinical decision-making skills that support optimization of patient flow. While the Emergency Nurses Association (ENA) has historically recommended ongoing competency validation to ensure safe practice in the ED, the organization updated itsTriage Qualifications and Competency Position Statementin 2017 to place greater emphasis on the use of retrospective chart review as a means to ensure accurate clinical decision-making in triage.
In addition to the ENA recommendation, here are five more reasons retrospective chart review is an effective part of a triage competency validation process:
Have you ever wondered as an Labor and Delivery RN how many hours during your shift you spend staring at fetal heart tracings? I’ll bet you have never tried to tally such a figure, but I’d venture to guess it encompasses not only a large portion of your daily practice, but an enormous part of your career as well. During a 12-hour shift of managing labor induction, you could easily spend approximately 5-6 hours or more actually staring at the monitor. That’s 50% of your shift! This translates into the possibility that half of your intrapartum career is immersed in FHR tracings!
In today’s case presentation, we will navigate the difficult waters of patient refusal of life-saving care based upon religious beliefs. In this actual case, a woman’s life hung the balance. There was little time for formal mental status evaluation or communication with legal counsel or a local judge.
It was around 8:30 pm during a busy shift in the Cook County Emergency Department. A young woman had been rolled into the department with low blood pressure.
Providing care to psychiatric patients in the emergency department is a challenge for many reasons.
- Emergency physicians often receive insufficient training in behavioral emergencies.
- ED personnel are uncomfortable evaluating and treating these patients.
- ED staff may harbor negative attitudes toward behavioral health patients.
- Resources such as consultants and inpatient beds are lacking.
- The hectic ED environment can lead to iatrogenic escalation of psychiatric crises.
For the ED, however, the greatest risk and safety issue related to behavioral health is the appropriate evaluation and protection of the suicidal patient in the ED. We present 2 case studies to illuminate the uncommon but preventable catastrophe of suicide in the ED.
Clinicians issue tens of millions of warfarin prescriptions each year in the U.S., despite the increasing use of alternative anticoagulant medications. Practitioners will continue to encounter warfarin, known both for its irreplaceable value and potential for life-threatening complications. Due to the propensity for permanent disability and death from hemorrhagic complications, litigation is common and costly. Knowledge of the pharmacology, indications, monitoring, drug interactions and complications of warfarin is an essential tool to avoid patient harm, medical errors, and the medical-legal vulnerabilities associated with its use.
Surgery Is a Team Sport
As a Vascular Surgeon, I have had the honor and privilege of serving not only as an Attending Surgeon, but as a Division Chief, Professor of Surgery, Surgical Residency Director and Chairman of Surgery. One’s perspective on incivility in the operating room (OR) depends on one’s position and responsibility. I was trained during a period of time when bombastic behavior by the senior surgeon was accepted, sometimes expected, and always legendary. Shall I admit to being a reformed sinner? Shouldn’t we all, in one way or another? My mantra to the residents, the attending staff, the OR staff (and anyone else who will listen) has always been that “surgery is a team sport.” When the team functions well, the patient does well.
Many would contend that we currently live in a polarized society in the United States. Whether the issue is the environment, healthcare, taxes, religion, economic theory, immigration, globalization or politics, interaction between competing philosophies is often characterized by animosity, accusations, verbal abuse, and even physical harm. Make no mistake — this has been going on since the Garden of Eden (Ask Cain; better yet, ask Abel!). The impact on society is rarely, if ever, beneficial.
Infants and children with acute abdominal pain present to emergency departments, urgent care centers and physician offices with a variety of signs and symptoms. Since infants can’t localize pain and pre-school children are often imprecise in their responses, the healthcare practitioner may find it difficult to ascertain the actual dilemma.
Intoxication! Talk about a red flag! Let’s consider two “flavors,” if you will. First, the patient with an actual chief complaint AND who happens to be intoxicated. Next, the patient who presents with apparent intoxication and no other immediately obvious issues. And for those of you who have not had a busy shift in an urban emergency department, the number of patients with altered mentation secondary to alcohol can be remarkable. Unfortunately, many of these patients get to be regular visitors; they are well known by the emergency providers and are often on a first-name basis.