Pain management in the acute care setting (ED, Urgent Care, office) has once again catapulted to the top of the list of hot topics. Years ago the conversation centered on recognizing pain as a “fifth vital sign” and navigating the tricky crossroad of patient satisfaction and the provision of timely, sufficient pain medication. In the Emergency Department, I witnessed every extreme of practitioner and patient behavior.
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As practitioners, we like to think our charm and skills are so valuable that no patient would possibly consider leaving the ED or hospital against our sage medical advice!
However, no matter how hard we try or how fast we work, a few patients will always choose to leave before an evaluation is complete—and against medical advice (AMA). Available data shows that about 1.2% of ED patients leave AMA.
Over the last few years, many of our clients have expressed interest in demonstrating the impact that various system-wide performance improvement initiatives might have on patient outcomes or financial metrics. One of our colleagues from a large hospital system recently posed a similar question about triage. Like many initiatives, given there are so many variables in play, it is extremely difficult to pinpoint a cause and effect with triage; however, let’s explore four areas in which you could expect to see improvements with an efficient, safe triage process.
Acute abdominal pain presents a significant challenge to all healthcare professionals who care for geriatric patients. The signs and symptoms may be atypical, the differential diagnosis is vast, the workup is time-consuming, and the stakes are high. It is estimated that of all elderly patients who present to the emergency department with abdominal pain, as many as 50% will require admission and 30%-40% will require surgery.
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.
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.
In a previous posting, “The Ultimate Loss Prevention Strategy: 4 Key Areas of Allocating Your Risk Management Budget,” we highlighted the importance of addressing Diagnosis-Related Adverse Events. As an extension of that article, Dr. Tom Syzek and I provide further detail for justifying that recommendation and the recent data surrounding diagnostic errors, after which we will outline three key attributes of successful initiatives that have led to positive results.
Thoracic aortic dissection (TAD) is one of the most dramatic and life-threatening conditions encountered in all of medicine. Every year in the United States, there are an estimated 6,000 to 10,000 cases of TAD. Since it is an uncommon condition compared to the 5 million ED chest pain visits and more than 1 million acute myocardial infarctions, most physicians have diagnosed and treated only a few patients with TAD during their careers.
Ever since the Institute of Medicine’s report To Err is Human was released in 2000, healthcare has seen a surge in patient safety initiatives. Analysis of medical errors has become increasingly widespread, with several different methods being used by hospitals and practitioners. Of these methods, I suggest that cognitive error analysis may prove to be one of the most valuable in determining the real underlying reasons for medical errors that lead to unexpected adverse patient outcomes.
As the healthcare industry constantly evolves and “return on investment” remains a focus, it is becoming more imperative that risk managers allocate their budgets in areas that have the greatest impact on mitigating claims and litigation.
Fortunately, The Sullivan Group has the luxury of working with many large, sophisticated, self-insured hospital systems as well as smaller single-site facilities and physician groups. This experience has helped us identify four key areas that an organization should consider when developing its loss prevention strategy.
