Emergency medicine clinics of North America
-
Emerg. Med. Clin. North Am. · May 2020
ReviewManaging Emergency Department Risk Through Communication and Documentation.
The job description of the emergency physician contains many responsibilities, including identifying and managing life-threatening illness, providing symptomatic relief, determining safe and efficient disposition, managing department flow, providing customer service, improving public health, and ensuring wise resource utilization. Emergency physicians must communicate effectively with patients, interdisciplinary clinical teams, and consultants, both orally and through the medical record. Excellence in clinical care as well as in communication and documentation is critical for managing risk in the emergency department.
-
As the number of advanced practice providers has grown in emergency medicine, establishment of guidelines and policies governing their practice has become increasingly important. This article addresses the scope of practice of physician assistants and nurse practitioners working in the emergency department, including the various forms of supervision and the effect on billing, credentialing, and medicolegal considerations in patients' care.
-
Emergency departments have always been busy, but persistent annual increases in volume and rates of admission have led to high levels of boarding patients, adding additional risk to the situation. This article reviews specific areas of risk as patients progress through their care in the emergency department and methods by which to mitigate this risk. Beginning with an overview of the current state, commonly used throughput metrics are reviewed before proceeding to a discussion of best practice strategies to decrease risk exposure at input, throughput, and output phases of the patient visit.
-
This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. ⋯ This article then discusses risk management issues relevant to determining a patient's capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for mitigating risk in informed consent and barriers to consent are reviewed.
-
More than half of pediatric malpractice cases arise from emergency departments, primarily due to missed or delayed diagnoses. All providers who take care of children in emergency departments should be aware of this risk and the most common diagnoses associated with medicolegal liability. ⋯ It highlights challenges and pitfalls that may increase risk of liability. It concludes with a discussion on recognition and management of abuse in children, including when to report and decisions on disposition.