Blog & Articles

[3 MIN READ]

Headache is a common reason for a visit to practitioners in primary care, urgent care, and emergency medicine. Patients with the chief complaint of non-traumatic headache comprise 3% of all emergency department visits.

The vast majority of these headaches will have a benign etiology such as tension or migraine. Unpredictably interspersed among these benign presentations are patients with a serious cause of headache such as hemorrhage or CNS infection.

Malpractice cases involving headaches frequently involve the missed diagnosis of subarachnoid hemorrhage (SAH). The reasons the diagnosis of SAH is missed include the following:

We've featured a variety of topics, cases, and missed diagnoses on our blog this year, and we hope that you've found the content useful and relevant.

In case you missed some of 2018's most popular posts, here are the top 10 articles from the blog this year, according to our website visitor statistics. Which article is most valuable to you?

[3 MIN READ]

The risks we face as acute care practitioners are not static—they evolve over time. Just as we master the approach to a longstanding high-risk problem, a new risky patient presentation rears its head to challenge us. Consider ectopic pregnancy. Now that we routinely obtain pregnancy tests on all women from age 10 to 60 and have access to or skills in ultrasound, the evaluation of possible ectopic pregnancy has become largely an algorithmically routine matter, and errors involving ectopic pregnancy have plummeted as a result.

In 2014, there were 885 million physician office visits. Over half of these visits occurred in primary care –family medicine, internal, medicine, pediatrics and others – but there are still hundreds of millions of visits to medical and surgical specialists as well.

Based on information available from journal publications and claims data, we assembled this list of the top ten risk and safety issues pertinent to ambulatory care settings. While this list is not exhaustive, it represents the majority of errors and pitfalls in ambulatory patient safety.

Medical errors related to vascular emergencies are common and costly. From head to toe, the vascular system is a fertile field for risk and error waiting to entangle the unwary practitioner.

• Starting at the top, the high-risk vascular entities include a trio of hemorrhages (subarachnoid, subdural, and epidural) and the ischemic duo of TIA and stroke. 
• In the chest reside some of the big hitters – acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection. 
• Moving south into the abdomen, we find abdominal aortic aneurysm, mesenteric ischemia, GI bleeds, retroperitoneal bleeds and traumatic hemorrhages.

Every day in the practice of medicine, hundreds of thousands of urine samples are tested. The maxim that states “all females between ages 10 and 60 with abdominal pain must have a urine pregnancy test” has been ingrained into our cerebral cortexes. Since the times of ancient medicine, the urinalysis has been used to screen for a host of diseases. The urinalysis is a vital tool in evaluating patients. However, as helpful as it is, it has also led many clinicians down the wrong path towards chaos. Two different cognitive medical errors come to mind when interpreting the urinalysis.

[10 MIN READ]

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!

This enormity speaks volumes to expectations of your ability to understand and manage the fetal tracing. Your knowledge base should be solidly comprehensive and your ability to articulate standardized definitions rapid. If litigation were ever to knock at your door, would you be able to defend your actions surrounding your interpretation and analysis of the FHR tracing?

Failure to recognize, failure to act, and failure to communicate have been cited as three litigious areas of concern regarding FHR monitoring. Let’s take a look at six common “pitfalls” that can get you into trouble regarding tracing analysis.

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.

If you ask leadership at many hospital organizations to name their highest current quality priority, many will respond that it is sepsis. In recent years, medical researchers have identified that key interventions dramatically alter the course of sepsis. Key factors such as early identification, early administration of antibiotics, and appropriate fluid loading significantly reduce morbidity and mortality. Hospitals and organizations that have followed the evidence have consistently demonstrated significant improvements in patient outcomes.