Blog & Articles

It’s estimated that between 3,000 and 8,000 people in the U.S. have Vascular Ehlers-Danlos Syndrome (VEDS), although many are undiagnosed. Because 50% of those with the condition do not have a family history, the road to diagnosis and expert care can be long. Many individuals with VEDS are not diagnosed until they have a life-threatening event, and 80% of VEDS patients will experience a major medical event by age 40; too many are diagnosed during autopsy.

The likelihood of someone coming into the emergency department unaware of their VEDS diagnosis is high, but a VEDS diagnosis can change the approach to a patient’s emergency and surgical care and outcomes. Therefore, it is critical to be familiar with this condition. Here we present a missed diagnosis case and its impact on the invasive interventions.

[10 MIN READ]

Updated: August 20, 2020

Navigating the ever-changing landscape surrounding the coronavirus pandemic is keeping everyone on their toes. Healthcare administrators and provider inboxes are packed with notifications and updates. We are all trying to sort through what is pertinent to hands-on patient care while doing our due diligence to remain up to date and well informed.

Early pandemic guidelines were based on expert opinion with little evidence to support recommendations. As the pandemic wears on and high-quality evidence becomes available, new recommendations will evolve supporting standardization of practice. While keeping current can seem daunting, it remains crucial for the safety of both you and your patients that you continue to do your best to remain knowledgeable and informed. The Centers for Disease Control (CDC) and the American College o Obstetricians and Gynecologists (ACOG) offer ongoing updates; patient handouts are available on these sites as well.

Provided here is a brief synopsis of newer updates (July/August 2020) specific to COVID and the obstetric population.

[6 MIN READ]

The national nursing shortage makes recruiting and retaining quality nursing staff extremely competitive. While facilities traditionally might have required 3-5 years of emergency department (ED) experience before training a nurse for triage, the lack of resources has forced some organizations into reducing the requirement to one year or less. As this requirement decreases, it is increasingly critical to have a well-defined onboarding path for nurses new to triage.

Additionally, having well-defined role expectations – especially during onboarding – can have a significant impact on a nurse’s job satisfaction and the likelihood they will stay with your organization.

[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.

7 minute read

It appeared to be a typical, run-of-the-mill board meeting at Hospital System “X.” Patient admissions had been slowly on the rise; healthcare teams seemed to be handling the increasing demand for services as the hospital facility continued to display an inviting appearance.

Early in the meeting, the hospital CFO presented the data requested by board members; suddenly things took a dramatic turn. Several months of data had revealed that a profit drain had developed within the system. And worse news was that month-to-month figures showed this was not just a temporary “blip” in financial performance, but that it had become a consistent and expanding downward trend. Hospital System “X” still was operating in the black, but not to the satisfaction of the board. They immediately called upon top management to identify the problem areas and propose appropriate solutions.

[4 MIN READ]

Every patient – regardless of the time of day or department to which they present – needs to encounter a high-quality experience. Improving patient experience and ensuring its consistency involves reducing the variability between departments, clinicians and shifts.

To achieve this high goal, you need to get buy-in from the entire clinical community – an effort led by clinicians for clinicians to help all truly understand and buy into the mission and purpose of providing a high-quality patient experience.

Using the industry analyses to galvanize organizational support for defining a provider-patient communication model is a great first step.

[7 MIN READ]

Among physicians, surgeons are at increased medico-legal risk compared to non-surgeons; they also have more medical malpractice claims and claims paid per year. Jena et al.¹ found that the probability of facing a claim varied from 15.3% in general surgery to only 5.2% in family general practice. In a recent review of National Practitioner Data Bank (NPDB) records, Schaffer et al.² noted that the number of paid claims per 1,000 physician years was 30.0 for general surgeons and only 7.1 for internal medicine. Although there are a number of factors responsible for this wide variation, the correlation between the physician-patient relationship and the risk of a medical malpractice suit is well established.

A recent study by Tibble et al.³ explored the incidence and classification of complaints about physicians, finding that surgeons attracted 2.3 times as many complaints as non-surgeon physicians. Although the thrust of the article remains valid and the implications are concerning, there are a few factors that modify the severity of the concern. 

[8 MIN READ]

We are all fallible. Despite their best efforts, physicians, nurses, other healthcare workers, and indeed all humans, make errors. It is an essential component of our being. It is widely accepted that a systems approach to error prevention can counteract this fallibility. Nonetheless, errors do occur. These failures can often be explained by the “Swiss Cheese Model” of error. Multiple processes are designed to prevent a type of error. Each individual process may be imperfect but used in combination one process will succeed where another may fail. Like the holes in Swiss cheese, when these imperfections are aligned and multiple processes fail, errors occur.

Below I present three cases from which we can gain perspective on how poor communication, systems errors, and cognitive bias contribute to surgical errors.

[3 MIN READ]

After investing in an ongoing triage training program, some emergency department (ED) managers and educators become frustrated due to gaps in the application of that education. The goal of triage is to rapidly identify and sort patients to ensure they receive the appropriate care in the right amount of time. Updated triage practice protocol and ongoing triage training helps ensure optimal patient triaging. Implementing changes though does not always come easily.