ED Management – March 1, 2023

Harsh Criticism for New Report on ED Diagnostic Errors

New research that might have injected renewed vigor into improving diagnostic performance in the ED has instead prompted much uproar. In the emergency medicine community, that discussion has been overshadowed by biting criticism about the data and the methodologies investigators used to reach their conclusions — and what some are calling unfair blame placed at the foot of emergency providers.

Patients with Nonspecific, Atypical Symptoms Could Be Misdiagnosed

An emergency medicine professor explains how providers can reduce risks for ED patients who present with unusual symptoms.

Tactics to Improve Diagnostic Performance When Caring for Older Adults

Experts in diagnostics and elder care recently discussed the unique challenges of coming to a correct diagnosis for older patients and how healthcare providers can improve their performance.

Emergency Clinicians More Worried About Patient Harm Than Lawsuits

In a survey of more than 1,200 ED attending physicians and advanced practice clinicians, respondents indicated they are more concerned about doing what is right for their patients (i.e., shielding them from harm and preventing poor outcomes) as opposed to focusing only on defensive medicine to prevent future litigation.

Organizations Take Issue with Data Regarding Nurse Practitioner Care in the ED

Professional nurse groups are pushing back against a working paper in which the authors suggested care delivered in the ED by nurse practitioners who are not operating under the supervision of physicians actually results in more resource use and higher costs than care provided by emergency physicians working in the same setting.

Researchers Study Imaging Use Rates Among Nonphysician Practitioners

Researchers recently discovered nonphysician practitioners, including nurse practitioners and physician assistants, ordered imaging tests 5.3% more often than physicians, potentially pointing to an opportunity to improve decision-making regarding judicious use of healthcare resources.

Nurse Practitioners Working in ED Pose Unique Legal Risks

If a malpractice claim is filed, and a nurse practitioner was involved in the patient’s care, his or her liability exposure will depend on how closely the practitioner was involved in the care. Is the care the practitioner provides and submits bills for within the scope of practice? Does the care reflect what the providers are credentialed to do based on their competencies?

Some Acute Chest Pain Patients Can Be Discharged Safely

Guideline authors recommend implementing high-sensitivity cardiac troponins and clinical decision pathways to safely discharge low-risk patients without additional testing. However, the decision pathway is not meant to replace the emergency physician's clinical judgment.

In Med/Mal Cases for Missed Central Nervous Pathology, Dizziness Is Factor

After reviewing dozens of malpractice claims, researchers learned patients who reported dizziness often were discharged home or admitted without anyone diagnosing central nervous system pathology. Patients presented to an ED and were diagnosed with migraine or other conditions. The correct diagnoses only became clear later. The subsequent lawsuits revolved around the first emergency physician missing the diagnosis at the initial visit.

Real-Time Capacity Data Help Cut LWBS Rates, Speed Care

Some adverse outcomes in ED patients could be prevented if actions had happened faster — if someone had been moved to the cardiac catheterization lab faster, secured an inpatient bed sooner, or undergone stroke treatment swiftly. If the patient or families sue for malpractice, plaintiff attorneys will scrutinize those time frames.