Advanced Practice Spotlight
Decreasing Malpractice Risk in the Emergency Department,☆☆

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Actively Participate With the Patient

Have a seat, and look the patient in the eye. Patients who are happy are less likely to pursue legal action if something goes awry.2 Further, have a discussion with the patient about your assessment and plan of care.2, 3 The primary role of a clinician in the emergency department is to assess and manage patients. Clinicians can be easily caught up in such technology as cell phones, tablets, computer screens, or numbers on charts. This is amplified in the emergency department where distractions

Review What Other Providers Have Documented

Along with actively participating with patients, reviewing what other members of the health care team have documented in medical records is paramount. As a health care team, different members ask different questions and, as such, are likely to pick up on symptoms or signs that the practitioner may have missed on the initial history and physical. Reviewing these documents and dealing with any contraindications or differences is key to maintaining complete and accurate records.2 However, a

Address the Abnormal

It is not uncommon for patients who are discharged from emergency departments to have multiple abnormal findings during their visits. This can include vital signs, physical exam parameters, lab tests, or radiological studies. Plaintiffs’ attorneys look for practitioners who did not deal with abnormal findings accordingly. Having an explanation for the abnormal finding is critical. If an adult patient is sent home with a heart rate of 110 beats per minute, have an explanation. The explanation

Explain Your Thinking

The medical decision-making (MDM) portion of the medical record is the single most important section to be completed. This section of the chart is a window into the brain of the practitioner who is treating the patient. The MDM section provides the practitioner a chance to explain in detail why certain treatment modalities were sought and why other treatment modalities were avoided. The MDM section should, in part, paint a picture of the patient’s ED visit and the treating practitioner’s line

Discuss Discharge

When preparing to discharge patients from emergency departments, patients and their families should receive timely, appropriate, and diagnostic-specific discharge instructions. Practitioners often think this involves printing a “canned” discharge text via computer software and having the patient sign on the dotted line. Discharge teaching spans beyond this notion.2, 4 Discharge instructions should be provided first by the treating practitioner and not the discharge nurse or medic. This

Implications

Many challenges exist in high-risk specialties such as emergency medicine. Medical malpractice has been a growing concern in emergency medicine, where stakes are high, and chaos is a part of emergency care practice. Taking the time to participate actively with patients, engaging them in their own care plans, providing sound and evidenced-based medical decision making, and providing appropriate discharge instructions will decrease the potential for medico-legal risk (Table 1).2, 3, 4

David Warren is Nurse Practitioner at Integrative Emergency Services, Dallas, TX.

References (4)

There are more references available in the full text version of this article.

David Warren is Nurse Practitioner at Integrative Emergency Services, Dallas, TX.

Earn Up to 6.0 CE Hours. See page 433.

Section Editors: Cindy D. Kumar, MSN, RN, AG-ACNP-BC, FNP-BC, ENP-C, and Darleen A. Williams, DNP, CNS, CEN, CCNS, CNS-BC EMT-P

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Submissions to this column are encouraged and may be sent to

Cindy D. Kumar, MSN, RN, AGACNP-BC, FNP-BC, ENP-C [email protected]

or

Darleen A. Williams, DNP, CNS, CEN, CCNS, CNS-BC, EMT-P [email protected]

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