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.

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.

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.

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.

[4 MIN READ]

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.

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.

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.

The majority of malpractice suits in acute care and emergency medicine involve patients who were discharged home.

These patients experienced an unexpected adverse outcome after they left the ED such as worsening of their illness or even death.

For many of these patients, the “bad outcome” could not have been foreseen — the workup was appropriate, the diagnosis and treatment were correct, and the patient was stable for discharge.

A number of discharged patients, however, might have been misdiagnosed and had red flags present at the time of discharge that were either ignored or not recognized.

In some of these patients with adverse outcomes, preventable hospital discharge medical errors existed.