Annals of EM Malpractice Editorial

Tom Benzoni benzonit at GMAIL.COM
Mon Mar 5 12:49:06 UTC 2018


Dr. Graber:
May be a fine point, but I don't think I worry about preventing malpractice
suits in the ED; that would be easy: raise the burden of proof.
There is no relationship (but random and/or communication skills) between
error and malpractice suits in the ED. I think your article noted bears
this out.
That said, communication and expectation management is crucial.
So is style, which is a subset of communication.

To mitigate error is another pursuit entirely.
We need but cannot have a "sterile cockpit" mentality, among other concepts.
When I most need the time, I have the least cognitive reserve and vice
versa.

A few hours ago, I have a patient with severe sepsis.
B/P by oscillometry  (MAP) 60 - 70 mmHg.
4 l NS later, no change.
Hgb = 5.9
Lactate = 5.6 (nl < 2.)

While entering orders for sepsis, we are given an order set that has no
relationship to clinical flow and thought patterns, but it does capture
structured data so the purchaser can get a rebate.
While ordering blood, there were no less than 40 mouse clicks. The Hgb did
not automatically populate, so I had to manually search for Sepsis with
Anemia to be allowed to order blood.
I am using very high end software for which this very large center paid a
fortune.
Meanwhile, I had at least 10 interruptions from nursing staff; do not
bother telling me I can ask staff to leave me alone. That is not acceptable
even to me.

tom

On Thu, Feb 15, 2018 at 12:48 PM, Mark Graber <
Mark.Graber at improvediagnosis.org> wrote:

> Thanks for posting this article Keel and welcome to our discussions.
>
>
>
> I’ll take issue with the implication in the editorial and the Venkat
> article <http://dx.doi.org/10.1016/j.annemergmed.2017.06.023> that there
> is nothing that can be done to prevent malpractice suits in the ED.  I have
> no argument with the findings that no practice characteristics have been
> identified *to date*, but would argue that the interventions we believe
> could improve diagnosis have not been evaluated in the ED setting so far.
> These include: Better patient engagement, better teamwork, better
> follow-up, and more use of clinical decision-support.
>
>
>
> We will have trouble eliminating the ‘crapshoot’ element, but to the
> extent that we could improve the diagnostic process, there’s hope that at
> least some fraction of claims could be avoided.
>
>
>
>    Mark
>
>
>
> Mark L Graber MD FACP
>
> President, SIDM
>
> Senior Fellow, RTI International
>
> Professor Emeritus, Stony Brook University
>
>
>
>
>
>
>
> *From: *Keel Coleman <keelcoleman at GMAIL.COM>
> *Reply-To: *Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>,
> Keel Coleman <keelcoleman at GMAIL.COM>
> *Date: *Thursday, February 15, 2018 at 8:43 AM
> *To: *Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject: *[IMPROVEDX] Annals of EM Malpractice Editorial
>
>
>
> Long time reader, first time poster.
>
> Attached find an editorial from Annals of Emergency Medicine regarding a
> study of malpractice claims.
>
>
>
> *The editorial reviews the current literature looking for three things:*
>
> *1. Are their practice patterns or decisions by EM providers that are
> associated with increased likelihood of being named in a suit? *
>
>  Answer: No. None that we can find.
>
>
>
> *2. Are there identifiers for EM providers that are associate with
> likelihood of being named in a suit?*
>
> Answer: Yes. Time in practice (number of years), and number of pts seen.
>
>
>
> 3. *What other avenues might we study to further understand patterns of
> malpractice litigation?*
>
> Answer: Look at your local patient-plaintiff attorney relationships.
>
>
>
> Given these answers, what can be done to first protect patients from the
> wages of defensive medicine, and deranged decision making driven by the
> fear of of litigation?
>
>
>
> Second, what can be done to support physicians who will certainly find
> themselves in the crosshairs of litigation despite doing 'the right thing'
> every day?
>
>
>
> Third, as the study of indemnity claims moves to focus on local
> variability of malpractice environments, how do we maintain objectivity and
> best practices when a care space becomes adversarial by virtue of its
> location?
>
>
>
> Thank you.
>
> Keel Coleman DO, MBA, FACEP
>
>
>
>
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST@
> LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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