Will electronic records raise the legal standard of care and increase malpractice risk?

From HCPlive, posting at Kevin MD:

As EHRs are widely adopted and the quantity of information about a patient expands dramatically, does provider liability increase even if the quality of care is vastly improved?

What happens if the quality of care really does get better but because of all the new and easily accessible information, the standard of care for legal responsibility increases? With EHRs, plaintiff’s lawyers will make the case that greater access to patient information should result in better diagnoses and treatment outcomes. As a result, even as quality increases, the legal standard of care will keep rising too, so that rather than fewer mistakes and fewer lawsuits, there are more of each since the information you “should have known” is now right at your fingertips.

In-hospital resuscitation: opioids and other factors influencing survival

From Therapeutics and Clinical Risk Management

Purpose: “Code Blue” is a standard term used to alertt hospital staff that a patient requires resuscitation. This study determined rates of survival from Code Blue events and the role of opioids and other factors on survival.

Methods: Data derived from medical records and the Code Blue and Pharmacy databases were analyzed for factors affecting survival.

Results: During 2006, rates of survival from the code only and to discharge were 25.9% and 26.4%, respectively, for Code Blue events involving cardiopulmonary resuscitation (CPR; N = 216). Survival rates for events not ultimately requiring CPR (N = 77) were higher, with 32.5% surviving the code only and 62.3% surviving to discharge. For CPR events, rates of survival to discharge correlated inversely with time to chest compressions and defibrillation, precipitating event, need for airway management, location and age. Time of week, witnessing, postoperative status, gender and opioid use did not influence survival rates. For non-CPR events, opioid use was associated with decreased survival. Survival rates were lowest for patients receiving continuous infusions (P < 0.01) or iv boluses of opioids (P < 0.05).

Conclusions: One-quarter of patients survive to discharge after a CPR Code Blue event and two-thirds survive to discharge after a non-CPR event. Opioids may influence survival from non-CPR events.

ER to clinic referral program

From News-Journal:

Good Shepherd Medical Center has launched a patient referral program that hospital officials say will help ensure emergency room patients get continuing care by matching them with doctors according to the patient’s specific needs.

The program, called CareDirect, is free, an announcement from the medical center said.

“There are a number of patients who come to the Emergency Department who do not have a primary care physician but need care for a non-urgent condition. The Emergency Department is not the ideal place for these needs to be managed,” said Ron Short, vice president of operations.

In 2008-09, about 30,000 patients without a primary care physician received emergency treatment at GSMC. Helping patients establish a relationship with a primary care provider lays the foundation for preventive care, which in the long run will improve patient health and reduce their healthcare costs, the announcement said.

“With CareDirect, we assist patients in establishing a relationship with a primary care physician,” Short said.

“Our CareDirect coordinators contact the physician’s office, schedule an appointment at a time convenient for the patient and provide the patient with the office paperwork before the patient even leaves the Emergency Department,” he said.

The hospital also follows up with the patient to make sure needs and expectations were met.

“Helping patients establish that critical relationship with a primary care physician and affording them access to the appropriate level of medical and preventive care is the right thing for our patients and the right thing for our community,” Short said.

CareDirect referrals are made to practices in Longview and surrounding communities that provide not only immediate care of the sick and injured, but also specialize in: adult internal medicine, pediatrics, newborn care, selected surgical procedures, office gynecology, community and preventive medicine, according to GSMC.

“Through the implementation of CareDirect, Good Shepherd seeks to reduce the number of Emergency Department patients without a primary care physician and improve patients’ continuity of care,” the announcement said.

Refusal of Pain Meds Leads to Murder of Physician?

From Kentucky.com via GruntDoc:

CORNETTSVILLE — A man seeking prescription painkillers shot and killed a doctor at a Perry County medical clinic Tuesday morning, according to state police.

Dr. Dennis Sandlin, 57, of Delphia died after being shot at Leatherwood/Blackey Medical Clinic in Cornettsville.

John Combs, 46, of Redfox in neighboring Knott County, was arrested after the shooting, state police said. Combs has been charged with murder.

Hospital Pharmacy (Armed?) Robbery

From MyFox8:

LEXINGTON, N.C. – Lexington Memorial Hospital is under lock down after authorities believe a woman ran onto the hospital campus after an attempted robbery at a pharmacy.

According to a hospital spokeswoman, Lexington police are on the scene and are guarding all entrances and exits to the hospital. Police are searching cars as they leave the hospital, and K-9 units have detected a scent in the emergency room.

Spokesman Kathy Sushereba said authorities believe a woman attempted to rob a hospital pharmacy around 3:30 p.m. and may still be on campus.

Visitors and patients are only being allowed to come and go through the emergency room entrance.

Authorities said the woman is believed to be armed.

Telemedical assistance for in-flight emergencies on intercontinental commercial aircraft

From the Journal of Telemedicine and Telecare:

We have conducted a three-year prospective study of medical incidents on a commercial airline. A telemedicine service was available via an on-board satellite phone. During the study period there were 3364 medical incidents. The most common incident was collapse (n = 2310, 57%). Telemedicine was used in 323 of the cases (9%). Neurological patients, mostly stroke and seizures, excluding psychiatric diseases, were seen in 27% of the telemedicine cases (n = 83). Most of the cases involved middle-aged people, not the elderly. The group of patients that needed diversion (n = 27) was compared to the cases staying on board (n = 275). None of the patients in the non-diversion group deteriorated. All unstable patients forced a diversion. Doctors on board used the service in more severe cases, whereas laymen used the service in less severe cases. The results of the present study demonstrate the advantage of using simple teleconsultation in cases of medical emergency on board an aircraft.