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The creation of a new area to quickly assess homeless and uninsured individuals, many requiring behavioral health services, has helped ease pressure on EDs in the Lee Memorial Health System in Fort Myers, FL. It has also earned the system a 2010 AHA NOVA Award for "Community-Based Alternatives to the Emergency Room."
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This is the first of a two-part series on documentation and ED liability. This month, we explore the legal risks of inadequate documentation and information that should not be omitted.
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"Many times, something as simple as a check mark as to whether the patient had anything to eat or drink while they were in the ED may become an important fact in the defense of a lawsuit," says Stimmel. Here are some of Stimmel's recommendations:
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Though myocardial infarction is often a key area of focus when it comes to ED misdiagnoses and subsequent lawsuits, appendicitis is another common and serious misdiagnosis in the ED.
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Last month's ED Legal Letter analyzed some recent tort reform court battles. This month, we review cases where physicians are suing state governments to stop them from pilfering the cash in patient malpractice compensation funds, and a few more cases litigating state and federal tort laws.
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"This takes the longest to document," he says. "I might not remember every piece of history I asked, or every part of the physical exam that I did, even with computer guidance," he says. "But I spend most of my time on medical reasoning."
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There are many things that factor into missing a diagnosis of appendicitis, says William Sullivan, DO, JD, FACEP, director of emergency services at St. Mary's Hospital in Streator, IL.
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You are on duty in the ED when the paramedics bring in a patient from the county jail who had tried to hang himself. When the patient arrives, you are told by the accompanying guard that the patient was found with a tightly twisted bedsheet around his neck and looped over the bedpost of the metal bunkbed.
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In the past decade, rapid response teams (RRTs) were broadly implemented to identify and treat patients on medical and surgical wards at risk for catastrophic deterioration and thus prevent death.