Intoxication! Talk about a red flag! Let’s consider two “flavors,” if you will. First, the patient with an actual chief complaint AND who happens to be intoxicated. Next, the patient who presents with apparent intoxication and no other immediately obvious issues. And for those of you who have not had a busy shift in an urban emergency department, the number of patients with altered mentation secondary to alcohol can be remarkable. Unfortunately, many of these patients get to be regular visitors; they are well known by the emergency providers and are often on a first-name basis.
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When most people think of triage, they think of nurses making sense of the chaos caused by 141 million annual visits to the ED. Patients who are part of this massive onslaught of unscheduled care arrive daily at any hour, and the first person they see is someone in triage, usually a nurse, whose job is to quickly figure out who needs to be seen in what order. In my early practice years, my ignorant impression was that triage was for dummies – all one had to do was just sit there and assign patients to a room.
Many years of experience and observation have taught me otherwise – that triage is where the best and brightest nurses should be.
There is only one thing that frightens an obstetrician more than a difficult shoulder dystocia delivery—getting a letter from a plaintiff attorney notifying you that you are being sued for alleged malpractice in a shoulder dystocia delivery you did several years ago.
What is especially upsetting is that you remember that delivery, how quickly everything happened, and how well you performed in the heat of the moment to save that baby's life. You did your best, but the result was still a brachial plexus injury.
There are a number of laws in the various states that prohibit the abuse or exploitation of certain classes of people. The classes of persons who are protected generally include those who are particularly vulnerable to abuse and who may be incapable of defending themselves. The prohibition against child abuse is inherent in virtually all state statutory schemes and is widely known. Less well known, at least outside the long-term care industry, is the prohibition against the abuse or exploitations of the elderly and other vulnerable adults.
Over the last seven years, there has been a significant increase in the number of physicians that are employed by hospitals and health systems. Many of those employment changes were driven by aspects of the PPACA that favored a more “integrated” approach to clinical care. Although the aggressive employment strategy has subsided, there remains a significant interest by hospital systems to more closely align with physician group practices. To this point, let’s explore 4 key areas that hospital systems may want to include in their physician integration strategy, or in some cases, their physician employment and onboarding process.
Most physicians are aware that there is a duty to provide reasonable care in the patient-physician relationship. Typically, malpractice liability does not extend to anyone outside of that relationship. However, there are certain extraordinary circumstances in which a physician may have an obligation to a third party, one that is outside the patient-physician relationship.
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.
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.
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” -- President George W. Bush, State of the Union Address, January 20, 2004
The move towards the electronic health record (EHR) has been under way for more than a decade now. Hospital administrators, healthcare insurers, IT vendors and government officials are touting the benefits of transitioning from paper to electronic records.
There have been some interesting, and some frightening, developments in case law relating to healthcare risk management since the last annual meeting of the American Society for Healthcare Risk Management (ASHRM). While these cases may not have national importance (yet), they have concerning implications for healthcare.