ED Management – September 1, 2022

Emergency Providers Scramble to Prepare for Treating More Pregnancy-Related Complications

Now that the Supreme Court has shifted abortion lawmaking decisions to the states, matters for frontline providers have become more complicated in multiple ways. In addition to tracking patchwork laws, providers must be prepared to manage pregnancy- or abortion-related complications that might have been better managed at clinics that provide appropriate services.

EMTALA Implications if ED Patient Needs Medically Necessary Abortion

It is a mistake for ED providers to be solely focused on what their state abortion law says, without also considering the bigger picture in terms of other legal risks and ethical obligations.

Should EDs Offer Contraceptives, Related Family Planning Education?

With many states implementing or planning to implement stringent new restrictions on access to abortion, some clinicians are urging their colleagues to take strong steps to ensure the contraceptive needs of women are met.

The Joint Commission Puts Providers on Notice Regarding Diagnostic Overshadowing

When patients present with existing diagnoses or disabilities, clinicians might attribute any symptoms to the existing condition. This is called diagnostic overshadowing, a type of cognitive bias that can cause unnecessary suffering, unsafe care, and adverse events related to missed or delayed diagnoses. Unfortunately, the problem occurs more often among groups already experiencing healthcare disparities.

Legal Risks if Psychiatric History Clouds Medical Decision-Making

Patients with these life-threatening medical conditions may report mood swings, personality changes, irritability or aggression, depressed mood, anxiety, or trouble concentrating. If appropriate history, physical exam, and diagnostic testing are not completed, medical emergencies can be missed. This is particularly common if physical exam findings are subtle.

New Details Emerge About Acute Flaccid Myelitis, Cases Could Surge This Year

Researchers uncovered evidence indicating enterovirus D68 directly infects neurons in the spinal cord, prompting an immune response that leads to the limb weakness that is characteristic of acute flaccid myelitis. Investigators shed important light on the disease process that takes place in children who develop this polio-like illness. This is progress that can help lead to better treatments.

Work on Improving the Care of Children with Medical Complexity

Emergency physicians identified significant challenges in providing high-quality emergency care to these patients. These include time constraints, the need to adequately review the expansive medical record for key information, and the need to contact known physicians when making treatment and disposition decisions. Respondents indicated communication with known providers and use of emergency information forms summarizing the child’s medical history were helpful.

Med/Mal Concerns if ‘Float’ Nurses Cover the Department

Of 2,575 nurses from 50 states and Washington, DC, 26.5% reported they were “floated” or reassigned to a clinical care area that required new skills or that was outside their competency, according to a survey. Almost half reported receiving no education or preparation before they were assigned to the new unit.

EDs Need Process for Incidental Radiology Findings

To lower the risks of “failure to notify” claims, institute clear protocols on who is responsible for dealing with abnormal test results. Educate patients on how to find out about their test results; this includes obtaining updated contact information. Finally, use electronic alerts to notify patients and providers when tests results are ready.