In general, practitioners don’t appreciate anything that “pops up” or gets in the way of their typical workflow. This aspect of some EMRs can cause dissatisfaction, even anger. A good example is warnings related to medication prescribing. In some programs, drug interactions of any severity and their complications litter the screen with overwhelming frequency. This simply becomes white noise and is soon ignored, sometimes to the peril of the patient as well as the practitioner.
In emergency medicine and presumably in urgent and primary care, one of the common failure-to-diagnose drivers is the failure to recognize or act upon abnormal vital signs. In one analysis of 90,000 patients that we published in Annals of Emergency Medicine, 16% of patients presented to the emergency department with an abnormal vital sign, and 10% of that group went home without a single repeat of the abnormal vital sign. That analysis came from over 200 emergency departments across the U.S., representing over 7 million patient visits annually. From a quick calculation, you can see there are a lot of patients with abnormal vital signs being discharged from EDs across the U.S., and there are undoubtedly failure-to-diagnose adverse events and significant morbidity in that patient group.
There are four time-sensitive emergencies that that every practitioner of acute care medicine should master to deliver the best possible care in the safest manner: Code Trauma, Code STEMI, Code Stroke, and today's topic – Code Sepsis. Depending on the specialty, practitioners are involved in sepsis care at one or more stages of sepsis. In the office, urgent care or ED, the first two stages are paramount – early recognition and aggressive resuscitation. Hospitalists and admitting practitioners continue the initial management through recovery.
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.
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.
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.
The healthcare industry will continue to have its radar locked on the issue of Patient Safety in 2017. Some of the targets and goals are only vaguely visible from the 30,000-foot level, while others are in clear focus on the ground before us. Depending on where you stand (or fly), opportunities abound to improve patient safety. Let’s take a forward look into 2017, starting high in the clouds and descending eventually to earth.
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Sepsis is a regular visitor in the news as cases of flesh-eating bacteria and the dramatic speed with which victims deteriorate hit the headlines. The failure to diagnose sepsis remains a critical issue as delays in diagnosis significantly increase morbidity and mortality.The entire emergency department, urgent care and primary care teams must be focused on early recognition and intervention. This has never been so important as today since evidence now points to interventions that can truly save lives.
There are approximately 21 million living U.S. military veterans, and the Veterans Health Administration (VHA) is the largest health care system in the country. Despite its size, the VHA is overwhelmed by the need to provide healthcare to the huge number of eligible veterans.
As a consequence of this high demand for care, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014, which allows veterans to seek government-funded care in the private sector under certain circumstances. This act may cause an influx of veterans into private physician practices.
