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Anyone recently considering an elective medical procedure knows that physicians' efforts in obtaining proper informed consent have become increasingly elaborate.
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The electrocardiogram (EKG) and x-ray of a chest pain patient in his mid-50s were both normal when examined by the treating ED physician. However, the physician's shift ended before the patient's lab results were back. Based on the test results that were back, the oncoming ED physician discharged the patient as "chest pain, non-cardiac." Several hours later, the lab results came back with critical values.
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The federal government, through the Emergency Medical Treatment and Active Labor Act (EMTALA), as well as some states such as California and Florida, mandates hospitals and physicians to provide medical services to anyone presenting to the hospital's emergency department (ED). Why shouldn't governmental liability protections, such as immunity and/or damage limitations, apply to providers of emergency services?
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This is the first of a two-part series on severe traumatic brain injury, focusing on the evidence for optimal care.
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Given the complex tasks of the physician scribes at Tri-City Medical Center in Oceanside, CA, you'd think that the technology they use to interface with the department's electronic medical record (EMR) from Cerner Systems would be anything but user-friendly.
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(Editor's note: In this special issue, we highlight an all-important topic: avoiding litigation. We cover issues such as department-level risk assessments, preventive actions to reduce risk; key areas of risk; a three-step strategy for risk management; changes in your department's culture to reduce risk; the use of patient satisfaction as a best practice; best practices and tools for physician, nurses, and other practitioners; admission of mistakes; and the critical role of patient advocates. We know you'll find a host of important strategies to hone your risk management program.)
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How can an ED manager reduce the risk of lawsuits once problem areas have been identified? Experts agree you've got to get to the root cause of those problems. Sometimes, they say, it might take the use of formal quality improvement tools such as root-cause analysis. Other times, it can be a simple as listening to patient complaints.
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ED experts agree that when patients feel they have been treated poorly, or that medical mistakes have been made, the most effective way of diffusing the situation and avoiding litigation is to listen carefully to the complaint, admit mistakes if they have been made, and then take concrete action to demonstrate your desire to prevent such mistakes in the future.
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Risk assessment might be a critical strategy to use in your effort to minimize lawsuits, but it shouldn't be the first, says Tom Syzek, MD, FACEP, director of risk management for Dayton, OH-based Premier Health Care Services.
