ED Legal Letter – January 1, 2021
January 1, 2021
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Pediatric Psych Visits Surging in EDs, Along with Medical Malpractice Risks
Before pediatric psychiatric patients are discharged from the ED, carefully document the visit and create a follow-up plan with a primary care physician or mental health professional. For patients presenting with suicidal ideation, a social worker or mental health clinician should develop a safety plan.
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Must-Have Documentation if ‘Low-Risk’ Chest Pain Patient Is Discharged from ED
Documenting an assessment with a validated scoring system and ensuring the timing of troponins is appropriate can reduce risk.
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New ED-Specific Trigger Tool Identifies Most Important Adverse Events
The patient safety movement emphasizes the need to focus on detecting harm — ideally, preventable harm — rather than just errors. Instead of remaining hidden, adverse events should be identified and shared.
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Artificial Intelligence Coming to EDs to Improve Stroke Diagnosis
Strokes, especially posterior circulation events, are associated with significant diagnostic error in the ED. Machine learning models can be designed to capture subtle signs and assist providers in catching cases that might otherwise go undetected.
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Vascular Complications Common Allegation in Lawsuits Against ED Nurses
It is unclear whether the claims involved IV infiltration, thrombophlebitis, pain caused by multiple sticks, or inadvertent arterial placement. Prevention efforts might include procedural training, integration of ultrasound in IV placement, or escalation of patients with difficult access to providers who specialize in IV access.
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Substance Abuse and Suicidal Ideation Commonly Coexist in ED Patients
Appropriate discharge planning, including tracking patients and measuring outcomes of follow-up tactics, is a key aspect of the emergency management of this population.
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ED Boarding Prolongs Length of Stay for Trauma Patients
One department changed its processes to reduce the number of patients who left without being seen — specifically, working to put a patient in front of a clinician faster. When the ED fixed this issue, door-to-doctor times and door-to-disposition times shortened significantly, and leave without being seen rates declined sharply.
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Home Monitoring to Determine Hospitalization Needs Among Discharged COVID-19 Patients
Discharging patients with a low-cost tool to monitor their own health can improve patient safety outcomes.
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EDs See Decrease in Low-Severity Illnesses, More Advanced Imaging
Perceived litigation risk has been often cited as one of the top reasons for ordering low-value imaging in many settings, including the ED. Higher costs and more radiation exposure (and hospitalizations) probably could have been avoided in many cases. Yet EPs know it is possible they will be sued for failing to order a diagnostic test.