Emergency medicine clinics of North America
-
Emerg. Med. Clin. North Am. · Nov 2009
ReviewHigh-risk chief complaints I: chest pain--the big three.
Chest pain is one of the most frequently seen chief complaints in patients presenting to emergency departments, and is considered to be a "high-risk" chief complaint. The differential diagnosis for chest pain is broad, and potential causes range from the benign to the immediately life-threatening. ⋯ Several atraumatic "high-risk" causes of chest pain are discussed in this article, including myocardial infarction and ischemia, thoracic aortic dissection, and pulmonary embolism. Also included are brief discussions of tension pneumothorax, esophageal perforation, and cardiac tamponade.
-
The combative or uncooperative patient is a growing problem in the emergency department. Restrained patients are at especially high risk of adverse outcomes. Particular attention has been given to de-escalation techniques to reduce the need for patient restraint. This article examines these techniques and the need for and risks of physical and chemical restraints in managing patients in the emergency department.
-
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.
-
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.
-
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.