Nursing Delays May Lead to Malpractice Suits
Did an emergency physician write an order for a magnetic resonance imaging (MRI) scan, but one cannot be obtained because the machine is being serviced? If so, the chart should reflect that the ordering physician was advised of the delay.
"It then becomes a physician decision as to transferring the patient to another facility to obtain the MRI, waiting until an MRI can be obtained in-house, or some other plan," says Edie Brous, RN, Esq., a New York City-based nurse attorney.
If it is not possible to implement an order immediately, she advises, the ED nurse should notify the ordering physician and document the reason for any delay, as well as the specific physician notified.
The failure to accurately capture the sequence of events in the medical record can make defending a future claim more difficult, Brous explains.
"Nursing delays that compromise the clinical status of a patient could lead to allegations that the nursing staff was responsible for deterioration in the patient's condition," she says.
If interventions are delayed, an ED nurse can be accused of malpractice in a lawsuit, or charged with professional misconduct or unsafe practice by a licensing board, warns Brous.
Brous says that the allegations are generally that the nurse failed to monitor the patient for status changes/foreseeable complications, failed to recognize status changes/foreseeable complications, failed to intervene with status changes/foreseeable complications, failed to notify a physician of status changes/foreseeable complications, and/or failed to pursue concerns to resolution.
To reduce legal risks involving delayed ED nursing interventions, use these strategies:
ED nurses should clearly document which specific physician was notified of what specific findings and concerns at what specific time.
Charting such as "MD aware" isn't sufficient to indicate that the nurse identified clinical information in a timely matter, says Brous.
ED policies and procedures should address the frequency of reassessment for triaged patients awaiting physician evaluation.
A patient who appears stable in triage may deteriorate rapidly after being assigned a non-emergent acuity classification, says Brous. "Because the ED is a diagnostic area, providers must maintain an index of suspicion for worrisome conditions," she adds.
Failure to triage someone accurately, resulting in delayed treatment that results in a poor outcome, puts the triage nurse "right in the forefront of litigation," says Paula Mayer, RN, LNC, a partner at Mayer Legal Nurse Consulting in Saskatchewan, Canada.
With the increased emphasis on reducing wait times in health care, nurses' decisions are subject to greater scrutiny by hospital authorities and the courts, says Mayer. "There are cases of triage nurses being sued for delays in treatments due to improper triage, and some of them have been decided for the plaintiff," she notes.
ED nurses should inform administrators if wait times are outside the standard of care.
The average wait time to see an emergency physician increased from 22 to 30 minutes from 1997 to 2006, according to one study, and the wait time for a heart attack patient increased from 8 minutes to 22 minutes.1
"Nurses need to be reporting to their administration if this is occurring in their ED, as the standard of care for myocardial infarction is an ECG within 10 minutes of the patient presenting to the ED with chest pain." says Mayer. " If this standard of care is not being met, the hospital is responsible for the adverse outcome."
If delays in ED care are due to administrative issues, this needs to be identified to hospital administration so that the issues can be addressed, stresses Mayer, and failure by ED nurses to identify such problems to administration puts the nurse at increased risk. "The courts won't care how busy you are just that you met the standard of care," she says.
Reference
1. Wilper AP, Woolhandler S, Lasser KE, et al. Wait to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Affairs 2008;27(2):w84-w95.
Sources
For more information, contact:
Edie Brous, RN, Esq., Nurse Attorney, New York, NY. Phone: (212) 989-5469. Fax: (646) 349-5355. E-mail: [email protected].
Paula Mayer, RN, LNC, Partner, Mayer Legal Nurse Consulting, Kamsack, Saskatchewan, Canada. Phone: (306) 590-8980. E-mail: [email protected]. Web: www.mayerlegalnurseconsulting.com.
Did an emergency physician write an order for a magnetic resonance imaging (MRI) scan, but one cannot be obtained because the machine is being serviced? If so, the chart should reflect that the ordering physician was advised of the delay.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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