ED Management – June 1, 2023

Give Actionable Incidental Findings Proper Attention

New recommendations help health systems implement processes that will preserve patient safety. These tips aim to make it easy for providers to do right by their patients when clinicians identify actionable incidental findings.

Malpractice Lawsuits Allege ED Missed Intracranial Aneurysms

Failure to image patients is a relatively frequent cause of litigation, but it should be seen in context. It is not so much incorrect interpretations of imaging studies; rather, failure to consider the possibility of an aneurysm, resulting in an inadequate workup, is a more common allegation.

Does a Clinical Decision Aid Constitute the Legal Standard of Care?

Each emergency physician should undertake the appropriate medical approach to evaluating a patient, regardless of any recommended course of action. The medical record should support using the recommended path or justify another course of action.

Did EP Decide Not to Follow Recommendation of Computer Decision Aid?

The medical record should demonstrate the clinician saw the recommendation, thought about it, and decided what to do. The clinician still may be wrong. But now, it is more of a judgment error than simple carelessness.

Med/Mal Claims Focus on Decision Aid Findings from ECGs, Radiology Tests

If the radiologist does not address computer findings directly, the ED clinician is left to make assumptions about what the radiologist has found significant or insignificant. If radiologists are not routinely addressing computer findings, emergency providers will spend resources attempting to sift through reports and images, trying to rule in or out what the computer has found. Radiologists should acknowledge computer findings, and comment on why or why not the finding is accurate and significant to the patient’s care.

Remote Facilities Can Avoid Unnecessary Pediatric Transfers by Leveraging Telemedicine

When critically ill children present to EDs in rural or community hospitals that lack access to specialty pediatric care, the solution often is to transfer them to a regional pediatric facility, which could be hours away from a patient’s home. This creates travel burdens and added expense for families and payors. But new research suggests that at least some of these interfacility transfers can be safely avoided by incorporating telemedicine consultations with pediatric specialists.

Homeless Pediatric Patients Use EDs Frequently

Homeless children frequently use EDs, defined as four or more visits in a calendar year, compared to housed children. These patients require hospitalization more often than housed children when they visited the ED, including to ICUs. This underscore the critical influence of housing as a social determinant of health.

Emergency Medicine Physician Groups Pledge to Tackle Workforce Challenges

Many experts note the burdens placed on frontline providers during the COVID-19 pandemic have taken a toll, and the apparent fall-off in demand for emergency medicine residency positions is not necessarily surprising. Nonetheless, there is concern suggesting solutions are needed to address multiple workforce challenges.

Emergency Physician’s Testimony Could Legally Expose Hospital

Airing grievances against the department, hospital, or health system will not serve the defendant in the long term. If a patient experienced a delayed diagnosis because of long waits, some providers might editorialize in the chart about why the delays happened or describe their personal efforts to bring the boarding crisis to the attention of leaders. A “just the facts” approach is better.

Unified Defense Not Always Possible in Malpractice Claim

Defense counsel must be aware of competing interests in any case. Attorneys should engage in frank discussions with the hospital and any employed staff who are named defendants. There must be a cohesive strategy. Individual staff members named in lawsuits should not be speculating on whether a staffing shortage existed, or whether a staffing shortage caused or contributed to a patient’s alleged injury.