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December 2007 Don't Wait
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Is the Emergency Department the site of
the next malpractice crises? Each year, approximately one-third of Americans visit a
hospital Emergency Department (ED). Those who are suddenly sick,
injured, or out of other health care options often encounter EDs that
are crowded, chaotic, and increasingly risky. More and more, patients
are being diverted to other facilities or—intolerant of extraordinary
wait times—choosing to leave without being seen. Even patients who are
admitted to the hospital may face the risk of extended ED boarding
before they are physically transferred to the admitting service. If EDs
have not already reached the tipping point in patient safety risk, they
are close. Background
The ED utilization rate grew seven percent from
1995-2005 and is expected to continue upward. A concurrent national
decline in ED facilities and reimbursement rates is further stressing
capacity and efficiency. With higher ED volume, patients experience
[pdf] longer waits, longer stays, and lower satisfaction…a scenario
with the potential for increased adverse events, dissatisfied patients,
and more malpractice lawsuits. From 2002-2006, CRICO saw 12.6
ED-related malpractice cases per year, representing $33 million in
incurred losses, with an upward trend especially for physicians who
practice Emergency Medicine. ED-related malpractice cases expose risks in every phase
of care from triage to diagnosis to discharge to test results received
after the patient has gone home. The largest percentage of cases allege
diagnostic errors: in particular, diagnostic fixation, substandard
communication among providers, and premature discharge. Inadequate test
results management and poor decisions regarding specialty consults are
also common factors in ED cases. Our Recommendation
Even if you think that your ED has a low risk profile,
don’t wait to begin your next improvement project. Work now to
preemptively identify and remedy your most egregious risks before
they are exposed by a plaintiff’s allegations. For example, in 2006,
CRICO/RMF developed a consensus statement
with its insured institutions to address the risks related to inpatient
boarding. In 2007, Boston’s Beth Israel Deaconess Medical Center
launched an ED dashboard
to improve the tracking of patients, test results, and specialty
consults. In 2008, seven Harvard-affiliated EDs will participate in a
team training/communication initiative aimed at improving patient
handoffs. These three Harvard ED initiatives are a small sample of
a national undertaking to get ahead of what appears to be a looming
convergence of risk, patient injury, and increased allegations of
malpractice. At this stage, it is too early to know which of these
efforts will serve to reduce risks to patients and providers. But, as
the successful programs gain exposure and adoption, perhaps a budding
patient safety crisis can be averted. Additional Materials
Daily battle
for beds strands MGH patients: Tough calls, and a long wait in ER.
Boston Globe. Oct. 21, 2007. Family of
Woman Ignored at ER Files Suit. ABC News. The Future of
Emergency Care in the United States Health System. IOM Report. June
2006. Code Blue
Crisis in the ER: A surefire recipe for disaster. The National
Report Card on the State of Emergency Simulating
Emergencies to Prevent Errors. CRICO/RMF. Narrow
Diagnostic Focus in the ED. CRICO/RMF. 2007. |
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