Blog & Articles

Although most of The Sullivan Group’s RSQ® Solutions platform is delivered online via CME/CE courses and clinical performance assessments, there is another major component to the RSQ® Cycle, which involves building clinical risk mitigation strategies directly into the EMR. In 2010, one of our largest clients requested that we develop a library of physician documentation templates for their enterprise EHR system, which happened to be MEDITECH. After several years of development with their medical leadership team, we deployed 137 chief complaint-specific templates with clinical decision support to all 163 emergency departments. Below we have included 2 videos from our President & CEO, Dan Sullivan, MD, JD, FACEP, that outline a few different workflows that can be used by providers to complete their documentation with our PDoc Templates.

Based on our experience, research, and an analysis of
thousands of malpractice cases in acute care, including
emergency departments and urgent care centers, we
have uncovered several critical risk and safety issues
of which you may not be aware.

There are four time-sensitive and life-threatening clinical presentations that every acute care practitioner must master to deliver the best possible care in the safest manner. The first two have been around a while and should be very familiar – Code Trauma and Code STEMI. The next two are less dramatic than trauma and heart attacks, but are no less critical – Code Stroke and Code Sepsis. Here are some highlights of Code Stroke.

With HITECH in full swing and hospitals and health systems across the nation implementing electronic medical record systems, some for the first time, many are finding that the MEDITECH solution, while fantastic for billing, coding and reporting, perhaps leaves a little to be desired where the end-users in the ED are concerned. Many ED providers accustomed to structured paper chart templates found themselves essentially unsupported on the EMR front. Answering the call for , we developed RSQ® Modules for EMRs solution. 

Too many patients in too little space subjected to inefficient processes. This is the essence of overcrowding in the Emergency Department. In the 40 years since 1975, the number of hospitals has declined from over 7,000 to about 5,700. Hospital bed capacity fell during the same period from 1.5 million to fewer than a million. Meanwhile, the number of ED visits has increased almost every year, totaling 136 million by 2011. The resulting formula for overcrowding is obvious: fewer hospitals + fewer beds + increased ED visits = overcrowding. Most hospital EDs (90%) experience overcrowding at some point. The practical consequence of overcrowding is boarding – when patients are kept in the ED for hours or days after the decision to admit them has been determined.

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.

Whether we like it or not, the future of medicine is geriatrics. As the demographics in the United States change in the next 50 years, it is predicted that practitioners will find themselves providing care to a much larger group of elderly patients. For example, the 2014 census data showed that 14.5% of the U.S. population was 65 years of age or older. By 2040, it is estimated that this age group will grow to comprise 22% of the population. People are actually living long enough to form a subgroup of elderly patients who are over 85 years old – the “super-elderly.” This crowd of the super elderly grew three to four times faster than the general population between 1990 and 2010.

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.

Physician workflow frustrations are cited by several studies as a significant contributing factor to physician burnout, an epidemic estimated to impact 51% of the physician population according to Medscape’s 2017 study. Because burnout can be tied to risks in patient safety, improvements in physician workflow are key components in the patient safety movement. 

Over the decades, physicians have worked with various medical record documentation styles. While this evolution is thought to improve patient care with each step, the majority of physicians and health systems have yet to maximize the potential of their documentation to improve patient safety. Moreover, each evolution might also be cited as being more complicated and time consuming for the physician, thus adding to their workflow frustrations.