Blog & Articles

It’s estimated that between 3,000 and 8,000 people in the U.S. have Vascular Ehlers-Danlos Syndrome (VEDS), although many are undiagnosed. Because 50% of those with the condition do not have a family history, the road to diagnosis and expert care can be long. Many individuals with VEDS are not diagnosed until they have a life-threatening event, and 80% of VEDS patients will experience a major medical event by age 40; too many are diagnosed during autopsy.

The likelihood of someone coming into the emergency department unaware of their VEDS diagnosis is high, but a VEDS diagnosis can change the approach to a patient’s emergency and surgical care and outcomes. Therefore, it is critical to be familiar with this condition. Here we present a missed diagnosis case and its impact on the invasive interventions.

[8 MIN READ]

Why was the diagnosis really missed?

In my previous position as Manager of Risk, Claims & Insurance for our physician group, the available methods of error analysis never satisfied my quest for the ultimate answer to this recurring question in any given case. The majority of our group practice was emergency medicine; our claims data mirrored the national trends showing that most claims were related to diagnostic error, which contained the allegation that a clinician was negligent by either not making the diagnosis in a timely fashion or failing to make the diagnosis entirely.

[4 MIN READ]

Every day, ED physicians, physician assistants, nurse practitioners and nurses are confronted with pediatric patients suffering from infections. Thankfully, most are self-limited respiratory or gastrointestinal viral infections.

Symptomatic and supportive care may be necessary, but antibiotics are not usually indicated; minor infections such as otitis media, impetigo, pharyngitis and uncomplicated urinary tract infections usually respond well to either oral antibiotics or a single parenteral dose of an antibiotic.

When treating an infant or a child with an infectious process, it is important to check for and recognize the subtle warning signs and symptoms of a more serious infection – whether viral or bacterial. When overlooked in their earliest stages, several types of infections can progress to life- or limb-threatening situations. Failing to consider and test for the possibility of serious infections in children can lead to serious, even fatal, outcomes.

[3 MIN READ]

Patients with abdominal pain are a common and constant challenge to practitioners in primary care, pediatrics, urgent care, and emergency medicine. During the period of 2006 to 2014, there was a 32% increase in ED visits for the complaint of abdominal pain, so that as of 2014, abdominal pain is the most frequent diagnosis for an ED visit. The clinical presentations may be confusing; the differential diagnoses for abdominal pain are myriad; and not all patients with abdominal pain will have a serious underlying etiology.

Medical errors and litigation involving the care of patients with abdominal pain are all too frequent and can be costly for both patients and physicians. The cornerstone of high-quality, defensible care consists of a systematic approach coupled with compulsive documentation. The essence of liability reduction in the care of patients with abdominal pain is to construct a medical record that provides a thorough, clear and logical explanation for your thoughts and actions. Here are a few key items to address in the chart documentation.

[4 MIN READ]

Child physical abuse exists in all corners of the country and affects children of all ages, ethnicities, and socioeconomic groups.

Consider the following facts:

• More than 2 million reports of suspected child maltreatment are investigated each year in the United States. These reported cases represent only a fraction of the abuse that children experience.
• Child maltreatment includes neglect and abuse that may be physical, sexual, emotional, or psychological.
• There are more than 650,000 substantiated cases of child maltreatment annually.
• About 18% of child maltreatment involves physical abuse.
• More than 1,500 children die each year due to abuse or neglect. 80% of these deaths are children under 4 years old.
• The incidence of child abuse is underestimated since 17% of adults in the U.S. report that they were physically abused as a child.

[6 MIN READ]

Physicians, nurses and other “healers” have had special relationships with patients for centuries. This unique bond between those who provide medical treatment and those who receive their care is currently being endangered by a massive and impersonal healthcare delivery system that is becoming more dependent on automation and technology with each passing year. The good news is that patient attitudes, impressions, and subsequent compliance with treatment plans can be positively influenced when healthcare professionals improve their communication skills with their patients.

Studies show that there is a clear relationship between high patient satisfaction and healthcare organizations that provide safe, quality care. A report by Health Grades (May 2012) noted that hospitals that were ranked (by patients) in the top percentages for nursing and physician communication had lower rates of adverse patient safety events. For example, bed sores occurred approximately 46% more frequently in hospitals that patients had ranked in the lowest 10% for provider communication.

[3 MIN READ]

Headache is a common reason for a visit to practitioners in primary care, urgent care, and emergency medicine. Patients with the chief complaint of non-traumatic headache comprise 3% of all emergency department visits.

The vast majority of these headaches will have a benign etiology such as tension or migraine. Unpredictably interspersed among these benign presentations are patients with a serious cause of headache such as hemorrhage or CNS infection.

Malpractice cases involving headaches frequently involve the missed diagnosis of subarachnoid hemorrhage (SAH). The reasons the diagnosis of SAH is missed include the following:

[5 MIN READ]

Despite the wake-up call given almost 20 years ago by the Institute of Medicine’s report “To Err is Human,” medical errors still occur at alarming rates.

The landmark publication estimated that up to 98,000 Americans die each year from medical errors, and one out of every twenty-five hospitalized patients is harmed by a medical mistake.

There is, however, cause for guarded optimism. Many organizations, agencies and legislatures have stepped forward and created solutions and educational programs targeted at reducing medical errors.

[4 MIN READ]

Patients with chest pain are a common and constant challenge to clinicians, whether in the office, clinic, urgent care or emergency department. The clinical presentations may be confusing, the differential diagnoses are myriad, and not all patients with chest pain will have a serious underlying etiology.

Lawsuits involving the care of patients with chest pain are frequent and make up the costliest group of malpractice cases in Emergency Medicine. The cornerstone of high-quality, defensible care consists of a systematic approach coupled with comprehensive documentation.

[3 MIN READ]

Malpractice claims related to the chief complaint of chest pain continue to plague clinicians. Foremost among these claims is the allegation of “missed MI,” which has now been expanded to include missed unstable angina as well as missed actual myocardial infarction.

Although the evaluation of the adult with chest pain is fraught with many pitfalls, one of the most glaring yet avoidable errors is the reliance upon “bedside maneuvers” to exclude the diagnosis of coronary etiology.