Medical Malpractice in the Emergency Department

From Managed Healthcare Executive:

The report, “A Dose of Insight — Emergency Department Risks: Through the Lens of Liability Claims” is based on an analysis of ED-related closed medical professional liability claims at Coverys across a five-year period from 2014 to 2018.

Overall, the report shows that EDs are the fourth-most common area to trigger a malpractice claim in healthcare settings—potentially making this a huge area of concern. The report also finds that:

  • 56% of claims involved a failure or delay in making a diagnosis
  • The most common conditions cited in allegations are cardiac or vascular illnesses (23%) and infections (18%)
  • 32% of the ED allegations involve permanent injuries and 38% involve grave injury or death
  • 49% of all medication-related allegations involve three types of medications: antibiotics, opioids, and anticoagulants.

Exploring the characteristics, acuity and management of adult ED patients at night-time

From the Emergency Medicine Journal:

Objectives ED care is required for acutely unwell and injured patients 24 hours a day, 7 days a week. The aim of this study was to compare characteristics and activity of type 1 ED attendances according to whether their time of arrival was during the day (08:00–18:00) or at night (18:00–08:00).

Methods Hospital Episode Statistics (HES) data from NHS Digital for all A&E and admitted patient care activity provided by all acute (not mental health or primary care) NHS hospital trusts in Yorkshire and Humber (1 April 2011 to 31 March 2014) for adult patients were analysed. Adjusted linear and logistic regression was used to model the data.

Results Adjusted regression analysis results show that patients who attended ED at night waited an extra 18.76 (95% CI 18.62 to 18.89) min to be seen by a clinician. They also spent an additional 13.64 (95% CI 13.47 to 13.81) min total in ED. Patients who attended at night were OR 2.20 (95% CI 2.17 to 2.23) times more likely to leave without being seen. They were also OR 1.26 (95% CI 1.25 to 1.27) times more likely to re-attend the ED and were OR 1.20 (95% CI 1.19 to 1.21) times more likely to present with non-urgent conditions. Overnight patients were more likely to be admitted to hospital, OR 1.09 (95% CI 1.09 to 1.10) times, however, those admitted were more likely to have a short-stay admission.

Conclusion There is an ‘overnight effect’ of patients attending EDs. Patients wait longer, leave without being seen, attend with non-urgent problems and are more likely to be admitted for a short stay. Further work is required to identify the potential underlying causes of these differences.

CMS proposes requiring hospitals to publish negotiated rates

From Modern Healthcare (subscription required):

The CMS issued several proposed rules on Monday that it hopes will make it easier for patients to understand the cost of a hospital service before accessing care.

Starting in January 2019, the CMS began requiring hospitals to publish their list of retail charges for healthcare services. The Medicare Outpatient Prospective Payment System proposed rule issued Monday would go a step further by requiring hospitals to not only publish their gross charges, but also the negotiated price by specific payer for a set of “shoppable” services. Those services could include anything that can be scheduled by a patient in advance

Hospitals Increasing Support for Antibiotic Stewardship

From MedPage Today:

While support for antibiotic stewardship programs increased across hospitals since 2013, surveillance for multi-drug resistant organisms stayed flat or ticked down, a small survey of healthcare facilities in the Society for Healthcare Epidemiology of America (SHEA) Research Network found.

Nearly all healthcare facilities, the majority of which were acute care hospitals, had antibiotic stewardship programs (95% in 2017 compared with 83% in 2013), and increased their support for these program medical directors and steward pharmacists, reported Kathleen Chiotos, MD, of Children’s Hospital of Philadelphia, and colleagues.

A next-day, brief e-survey overcomes the excessive variability seen in CAHPS-style emergency department surveys so that individual physician performance can be assessed on a regular basis

From the Patient Experience Journal:

Traditional CAHPS-style emergency department (ED) surveys result in excessive variability when assessing individual physician performance. The objective of this study is to measure the variability of a brief, electronic survey (e-survey). The study team also measured the association of individual physicians to demographic data, physician and patient factors, and a physician burnout assessment tool. Data from SmartContact (SmartER, La Grange, IL) is a next-day, e-survey that takes about 30-seconds to complete. This tool was used by a hospital-employed emergency department (ED) group during calendar year 2017 across 2 EDs and 37 physicians.1,2 Variability was estimated regarding raw patient experience (PX) scores and top box scores by using intraclass correlation coefficients (ICCs). Pearson correlations were used to measure the interaction between PX scores, physician factors, and patient factors. Analysis of the 2017 calendar year showed statistically significant differences between physician PX performance on a bimonthly and quarterly basis. As well, there was lower PX in patients presenting at night. No correlation was found with a burnout assessment tool. This study demonstrates statistically valid performance differences among physicians using a next-day e-survey, which conforms to the recommendations of ED professional organizations for use in driving provider PX improvement, enhancing patient trust, and improving patient outcomes.

State Aims To Reduce Unnecessary ER Visits By Empowering Paramedics

From Civil Beat:

Minor wounds, rashes, gout pain — these are some of the many medical conditions that should be taken seriously, but they may not merit a 911 call or a trip to the emergency room.

Hawaii health officials are considering how to reduce unnecessary ER visits through a community paramedicine program. The revised emergency transport system that could begin next year would allow medical professionals to transfer patients to predesignated destinations, such as urgent care clinics, or even provide complete treatment at the scene.

“Can paramedics go treat people in the field, in the community setting under a physician’s direction, and offer a treatment when they don’t need to go anywhere?” asked James Ireland, a nephrologist and the former director of the Honolulu Emergency Services Department. “Can they do some simple wound cleaning and start the patient on some antibiotics under the guidance of a physician? I think that’s where the huge cost savings can be.”

ER doctor, students invent device for common hospital complaint: rings stuck on fingers

From the CBC:

The product now uses a simple air pump attached to a ring that slips on a finger, somewhat resembling a mini air-pressure cuff. The process takes about five minutes for the typical case.

Spencer said as they started showing off their prototype, most people asked why it hadn’t been done before.

Two years later, he and his team have now established a business, Ring Rescue, and their made-in-Nova Scotia solution will be commercially available in mid-August.