History
[9 MIN READ]
Remember paper T sheets? Your patient has back pain, so you grab a paper T sheet from the anatomical rack, walk into the exam room, get your history, make some circles and slashes, and your history and physical is all but complete by the time you get back to your desk. Write in (remember writing?) some MDM and ‘ba-da-boom’, the chart is done. The focus was on easy documentation and receiving appropriate reimbursement for the care provided.
In 2019, the World Health Organization categorized burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. While burnout was a concern before COVID-19, its onset has exacerbated the problem.
According to an ACEP October 2020 poll, 87% of emergency physicians reported feeling more stressed since the start of the pandemic, and 72% reported experiencing more burnout on the job.
On the surface, burnout may be classified as a workforce issue; however, its far-reaching effects can threaten patient safety. In fact, research suggests that physicians experiencing burnout are twice as likely to make a medical error. Burnout should absolutely be considered one of the root causes of medical error.
Despite almost two decades of attention and study, diagnostic error continues to be a main issue in healthcare, affecting an estimated 12 million people each year and causing harm in one-third of these cases.
The most comprehensive literature on this topic comes from “Improving Diagnosis in Health Care,” in which the first recommendation is to “facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families.” Specifically, it calls for increasing nursing engagement in the diagnostic process; no longer is the diagnostic process the sole purview of a physician. Here we use a case review to demonstrate the importance of nurses in reducing diagnostic error and saving patient lives.
[6 MIN READ]
Any discussion of communication in healthcare must include the process of transferring patients and their vital medical information from one provider to another and/or from one healthcare setting to another.
Such transfers are known as healthcare handoffs.
Examples include when a patient is transferred from an ambulance to an ED or when a surgical patient is moved from the recovery room to a surgical floor.
A person-to-person handoff takes place when, for example, a physician going off duty signs off to the evening on-call doctor or when nurses report to each other at shift changes.
Handoffs are specific circumstances in healthcare that are prone to medical errors.
[5 MIN READ]
Before the COVID pandemic, the medical community in general, and physicians in particular, were dealing with and continue to deal with a pandemic of its own: Burnout. In 2019, burnout was categorized as a disease by the WHO. It is characterized as:
“…a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”
There are 3 dimensions of burnout:
History
A 25-year-old man presented to the ED with the chief complaint of low back pain. The pain onset gradually about 10 days prior, days after he lifted some furniture. The pain was described as dull and constant, with an intensity of level 7 out of 10 and getting worse in the past few days. He also had milder pain in the mid-back. Nothing seemed to make the pain better, and movement made the pain somewhat worse. He denied any prior back injury or surgery.
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.
[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.
