[5 MIN READ]

In prior blogs, I reviewed the bare-bones of EMTALA, highlighted recent studies of EMTALA investigations, and summarized recently settled cases of EMTALA violations. In this installment, I outline the requirements of EMTALA as they relate to the role of the on-call physician.

EMTALA was passed to prevent the dumping of “non-paying” patients between hospitals. With the enactment of EMTALA, the dumping problem has diminished. The on-call physician plays a key role in patient management under EMTALA.

The “emergency medical system” depends upon emergency department access, availability of specialist physicians through the on-call roster, hospital bed and staff availability, and a referral system for tertiary or highly specialized care.

[9 MIN READ] 

Hospital discharge is cited as a vulnerable point in a patient’s care transition.

Its effective execution has significant implications on a patient’s recovery trajectory.

The most effective tool in a clinician’s toolbox to promote patient healing is the effective delivery of communicating discharge instructions for patients.

The Wrong Way to Communicate Discharge Instructions

Before discussing best practices for reviewing discharge instructions with patients, let us review what patient discharge should NOT look like:

[8 MIN READ]

I recently reviewed the bare-bones of what EMTALA is and highlighted recent studies of EMTALA investigations.

In this installment, I have summarized nine recently settled EMTALA cases in which monetary penalties were levied by OIG against the hospital that serve to illustrate the factors responsible for alleged violations.

[5 MIN READ]

EMTALA violations can be a costly lesson for both healthcare providers and organizations. EMTALA is an acronym for the “Emergency Medical Treatment and Labor Act.” This statute was enacted in 1986 for the original purpose of preventing dumping – the practice of refusing service to patients in the emergency department for financial reasons. The final EMTALA statute now extends beyond this initial noble goal and prohibits discrimination against ED patients for any reason.

[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.

[9 MIN READ]

I certainly don’t pretend to have the answer to the question of how to eliminate the opioid epidemic. There are legislative, regulatory and policy issues far greater than any one of us, but what can the medical community do? This was the call to action by Stephen Stack, President of the AMA, who also happens to be an emergency physician. Dr. Stack clearly labels this as an epidemic and says we have to do something.

[12 MIN READ]

For the past two decades, the U.S. has experienced alarming rates of opioid use, misuse, abuse, and overdose deaths, and we are now ground zero for the opioid epidemic. This epidemic is rife with risks for patients, practitioners, insurers, healthcare organizations, communities, and our entire society. This is the first article in a three-part series in which we’ll explore the opioid epidemic, liability trends related to opioid prescribing, and strategies to reduce harm from opioid prescribing and abuse.

[6 MIN READ]

(adapted with permission from the original by Dr. Tim Kubacki at https://kubackisinangola.com/)

Dr. Tom Syzek: These days we hear so much about the importance of communication and teamwork in avoiding medical errors and how we deliver care at the end of life, I thought for perspective, I would share this case presentation from Dr. Tim Kubacki. Tim is a friend and colleague who left behind the comfortable life of an emergency physician in central Ohio to serve with his family as a medical missionary for 6 years in the jungle interior of Brazil, and for the past 5 years in medically underserved rural Angola. Tim recounts beautifully this medical case of mistaken identity, driving home the point that communication and teamwork are the essence of patient safety, while at the same time describing the only “end-of-life care” available.

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.