Blog & Articles

When a patient presents with chest pain or chest-related symptoms, the role of the triage nurse is to critically evaluate the relationship of risk factors to outcome potentials to make the best triage decisions. The more risk factors a patient has, the greater the triage nurse’s concern for a potential high-risk scenario. In this blog, we will propose several triage questions for chest pain and consider several serious concerns that can prompt a patient to present with chest-related complaints, not all of which involve the heart:

Accurate triage of patients in an emergency department is critical to timely care and patient safety. 

Read these four clinical tips for triage nurses based on recent trends spotted by RSQ® Collaborative Triage Champion, Shelley Cohen, RN, MSN, CEN. 

Download these tips as a PDF.

As a follow-up to last week’s article The History of EMRs: Opportunities to Improve Patient Safety, we explore the philosophy around providing EHR documentation templates that include specialty-specific, chief complaint clinical content. Doing so provokes a few big-picture questions about healthcare information technology and the appropriate strategy for designing clinical applications that providers work with daily.

With preeclampsia affecting 10% of all pregnancies and rates rising by 25% in the past two decades, it is important to test your knowledge and ensure that all your patients have a strong understanding of the dangers of preeclampsia. This is part II of a two-part series. Part I focused on definitions, risks, prevention and diagnosis of preeclampsia; part II focuses on HELLP syndrome, treatment, eclampsia, future risk and resources.

The case presentation will be a little different than our typical failure to diagnose an aortic disaster or other common “failure to diagnose” entity in emergency medicine. Although those are great teaching cases, there is another critically important side to the patient safety coin. It is critical to do the appropriate testing to identify potentially fatal presentations, but it is equally important to understand when such testing is inappropriate − testing that itself may by unnecessary and may actually cause morbidity.

Many organizations that study medical liability trends often point to breakdowns in communication, cognitive errors, lapse in clinical judgement, etc. as the main contributing factors that cause diagnosis-related claims. Because 60% of Emergency Medicine claims are diagnosis-related, every health care organization should have a strategy for mapping and organizing the most common clinical risk areas that physician’s face. Below we outline a tool that aims to help health systems organize a strategy to address the most frequent and severe malpractice claims.

Diagnostic error poses a significant threat to patient safety. According to a 2007-2013 closed claims analysis from The Doctors Company, missed or delayed diagnoses are responsible for 57% of malpractice claims in emergency medicine.

Before we can design patient safety initiatives to address diagnostic error in our organizations, we must first understand the breadth of the issue. This infographic outlines the scope of diagnostic error and breakdowns in the diagnostic process that can lead to error.

In this case, we present an incredible day-by-day progression from the moment of onset of a vertebral artery dissection as told by the emergency physician
who had it!

Vertebrobasilar artery thrombosis or dissection affecting the posterior circulation can be extraordinarily difficult to diagnose. In the failure to diagnose specialties such as
primary care, internal medicine, family practice, emergency medicine and urgent care where the door is open to all, risk and safety education and evaluation focused around this deadly high-risk clinical entity is critical.

The chief complaint of chest pain is common among patients presenting to the office, clinic, urgent care or emergency department. While heart disease is the leading cause of death in the U.S., medical error is the third leading cause. Furthermore, missed or delayed diagnoses are responsible for 57% of malpractice claims in emergency medicine, according to a 2007-2013 closed claims analysis from The Doctors Company.

This infographic outlines common errors in chest pain diagnosis that can lead to an adverse event. Download as a PDF.

The Dangerous Discrepancies

One of the most difficult hurdles to overcome during the defense of a malpractice suit is a significant discrepancy in the medical record. The discrepancies may involve the nurses, physicians, advanced practice clinicians, EMS personnel, and any records related to the patient. Often, a discrepancy may be nothing more than a minor difference in terminology; but the cases reviewed here reveal serious discrepancies between the physician and the nurse chart in the first case and the physician and EMS record in the second case.