Emergency medicine clinics of North America
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Being named in a malpractice case may be one of the most stressful events in a physician's career and participating in a trial is likely to be remembered for a lifetime. Despite the climate of tort reform, it is a system that is unlikely to change anytime soon. By understanding and knowing the system and proactively participating in one's own defense, the traumatic experience of being named in a malpractice case may be mitigated.
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Emerg. Med. Clin. North Am. · Nov 2009
ReviewCritical aspects of emergency department documentation and communication.
This article focuses on the unique environment of the emergency department (ED) and the issues that place the provider at increased risk of liability actions. Patient care, quality, and safety should always be the primary focus of ED providers. However, the ED chart is the only lasting record of an ED visit, and attention must be paid to proper and accurate documentation. This article introduces the important aspects of ED documentation and communication, with specific focus on key areas of medico-legal risk, the advantages and disadvantages of the available types of ED medical records, the critical transition points of patient handoffs and changes of shift, and the ideal manner to craft effective discharge and follow-up instructions.
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Emergency department (ED) crowding and ambulance diversion has been an increasingly significant national problem for more than a decade. More than 90% of hospital ED directors reported overcrowding as a problem resulting in patients in hallways, full occupancy of ED beds, and long waits, occurring several times a week. ⋯ This article gives a basic blueprint for successfully making hospital-wide changes using principles of operational management. It briefly covers the causes, significance, and dangers of overcrowding, and then focuses primarily on specific solutions.
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Emerg. Med. Clin. North Am. · Nov 2009
ReviewRisk management for the emergency physician: competency and decision-making capacity, informed consent, and refusal of care against medical advice.
This article focuses on those times that the emergency physician (EP) and patient do not agree on a treatment option. Attention is placed on the risk management issues relevant to the patient's unexpected choice. ⋯ The EP should have a strategy for assessing clinical decision-making capability and an understanding of what circumstances should act as a trigger for considering such an assessment. Attention to documentation issues around informed consent, common barriers to consent, refusal of care, and ED discharge against medical advice are examined.
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Emerg. Med. Clin. North Am. · Nov 2009
ReviewHigh-risk chief complaints III: abdomen and extremities.
Abdominal and extremity complaints are a frequent reason for presentation to the emergency department. Although these are common complaints, several abdominal and extremity disease entities may be missed or may be subject to delayed diagnosis. This article provides an overview of the diagnosis and management of several high-risk abdominal and extremity complaints, including appendicitis, abdominal aortic aneurysm, mesenteric ischemia, bowel obstruction, retained foreign body, hand and finger lacerations, fractures, and compartment syndrome. Each section focuses primarily on the pitfalls in diagnosis by highlighting the limitations of history, physical examination findings, and diagnostic testing and provides specific risk management strategies.