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Preventing bloodstream infections among the most costly and potentially fatal patient complications provides a benefit so powerful that one is tempted to dismiss the risk.
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Although efforts to cut the overuse of antibiotics have made some headway in hospitals, the majority of prescriptions are written by community-based clinicians often for pediatric patients with common ailments.
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Measuring the number of ED malpractice claims that are avoided by calling patients post-discharge is difficult, acknowledges Jeanie Taylor, RN, BSN, MS, vice president of risk services for Emergency Physicians Insurance Company (Epic) in Roseville, CA. "It is hard to measure what did not occur, so the effectiveness of callback programs from a claims perspective is largely anecdotal," she says.
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The most significant legal risks in the ED are not those associated with boarding patients or high-acuity traumas, but rather, those associated with relatively stable patients with undifferentiated diagnoses, according to an analysis of malpractice cases occurring from 2006 to 2010 from Crico Strategies' Comparative Benchmarking System database.
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Whether an emergency physician (EP) has deviated from the accepted standard of care on the basis of timeframe depends on the facts of the individual case, says Robert D. Kreisman, JD, a medical malpractice attorney with Kreisman Law Offices in Chicago.
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If the hospital isn't named in a medical malpractice lawsuit, an emergency physician (EP) defendant can sometimes take advantage of the "empty chair" defense strategy, says Joseph P. McMenamin, MD, JD, FCLM, a partner at Richmond, VA-based McGuireWoods LLP and a former practicing EP.
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In one case involving the death of a 9-year-old girl from a reaction to metoclopramide, misdiagnosed as gastroenteritis, the patient and her 16-year-old brother were called on in the ED to interpret for their Vietnamese-speaking parents.
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An elderly man presented to an emergency department (ED) with new-onset chest pain. In reviewing the patient's electronic medical record (EMR), the emergency physician (EP) noted a history of "PE," but the patient denied ever having a pulmonary embolus.
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After interviewing hundreds of patients and family members, a multi-disciplinary team at Kaiser Permanente redesigned the process for transitioning patients from the hospital to home and developed a list of six processes that should happen during every discharge for every patient.
