We frequently review emergency medicine medical malpractice claims for merit. ER cases are unique in that they involve a brief but critical encounter between patients and doctors, who have no previous relationship, in a setting where life and death decisions are rapidly made. There are two types of ER encounters: (1) those involving trauma; and (2) those arising out of acute or emergent medical and surgical conditions. When possible, trauma cases are managed by a trauma team led by a trauma surgeon. The standards for trauma care arise pursuant to best practices of trauma surgeons who are certified by the American College of Surgeons (ACS). Non-trauma emergency cases are governed by best practices of ER doctors certified by the American College of Emergency Physicians (ACEP).
Duties of an Emergency Medicine Doctor
The duties of an ER doctor are summarized in The Academy of Emergency Medicine’s 2011 Model of the Clinical Practice of Emergency Medicine. The key duties include (1) determining the severity of the situation; (2) stabilizing the patient; (3) ordering appropriate tests and consults to reach a preliminary diagnosis; and (4) deciding whether the patient can be discharged or admitted to the hospital. As a medical attorney practicing throughout the State of Ohio (we are based out of Cleveland but have handled medical negligence cases in all of Ohio’s major cities and over a third of Ohio’s 88 counties), I am often asked to review cases arising out of an ER encounter.
In determining whether ER care fell below accepted standards of medical care, a medical malpractice attorney should look carefully at several issues. First, was the patient timely and properly triaged? Second, was the initial nursing assessment timely and thorough? Third, did an ER physician assess the patient and create a differential diagnosis that includes potential life-threatening conditions? Next, did the ER physician undertake appropriate tests to rule in or rule out the conditions in the differential? Then, based on the investigation and test results, did the ER physician make a proper decision as to whether to admit or discharge the patient? If the decision was to admit, did the ER physician accurately communicate the significant findings and test results to the admitting doctor? If the decision was made to discharge, were clear and appropriate discharge instructions given? Finally, before discharge, did a nurse perform an assessment and vital signs to be certain the patient’s condition did not deteriorate?
Medical malpractice cases involving emergency medicine require careful examination of hospital records, an understanding of the underlying disease process and the workings of an ER department. There are a number of times during an ER visit when a medical mistake can be made, especially when ER personnel are too busy, not thorough or fail to communicate with each other and their patients.
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