ED Legal Letter – April 1, 2021
April 1, 2021
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Legal Implications for ED, Hospital if Triage Nurse Orders Testing
The authors of a recent analysis examined 13 studies about nurse-ordered testing at triage. Ten studies were about length of stay or time to diagnosis. The authors of the other three compared tests ordered at triage with tests ordered by emergency physicians. There were some surprising findings.
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Few Hospitals Violating ‘Good Faith’ EMTALA Requirements for Admitted Patients
An ED patient is admitted, but then is transferred almost immediately. This kind of situation can call into question whether the admission was “good faith” or if the hospital was just trying to work around federal EMTALA requirements.
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Shortness of Breath in Older Adults Is Challenging Diagnosis in ED
Older adults might present with atypical symptoms, such as “just not feeling right.” Some experience a decreased sensation of dyspnea itself, so they do not even report feeling short of breath. Older patients also may present with various comorbid conditions that are causing shortness of breath, such as congestive heart failure or COPD. This can lead to misdiagnosis.
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Discrepancies in Overread of Radiology Studies Pose Legal Risks for EDs
Some argue the costs outweigh the benefits of in-house, overnight attending radiologists. A recent paper provides new evidence of benefit to providing this service.
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Considerable Legal Risks for EDs if Discharged Patients ‘Bounce Back’
Patients with a history of substance abuse or chronic pain were most likely to “bounce back” to the ED, according to the authors of a study.
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Legal Standard of Care Is Evolving for ED Patients with Opioid Use Disorder
An ED visit from someone with opioid use disorder is an opportunity to put that person in treatment. People do not present to the ED when things are going well; they present at times of crisis. Sometimes, in that crisis, there is a wakeup. If the system offers some approaches and a treatment pathway, then everybody benefits.
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New Data on Opioid Prescribing Guidelines and ED Practice
Opioid prescribing guidelines were linked to small changes in morphine equivalent units ordered in the ED, according to the authors of a study.
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Emergency Medicine Trainees More Likely Sued Than Radiology Trainees
Expanding the frequency and improving the quality of communication between radiologists and emergency physicians about imaging studies is always a good practice to facilitate patient care and mitigate mutual risk.
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Lawsuits May Allege Failure to Obtain Dermatology Consults
Shutting out dermatologists can leave a gap in specialty care. This might lead to other specialists consulting and managing conditions outside their scope, or they might transfer patients to a different, distant center.
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Analysis: Few EMTALA Violations for Vascular-Related Issues
The most frequent vascular-related violations specifically involved lack of vascular specialist availability. Developing specialist networks and maintaining adequate call coverage can help improve patient access to emergency services.