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Medical Errors & Communication Between Doctors & Nurses

Usually overcrowded and frenzied, the emergency room is one of the top hospital departments sued for malpractice suits—and diagnostic errors account for 37% to 55% of cases in studies of resolved claims with the average amounts of payments and legal expenses for ER cases have more than doubled over the past two decades.  Of these cases, examples of the emergency room malpractice cases include:

  • An 18-year-old man with fever and chills is sent home with Tylenol and later dies of sepsis, a blood infection.
  • A 42-year-old woman with chest pains is discharged and suffers a heart attack two hours later.
  • A 9-year old girl was told she only had a bellyache only to have her appendix rupture.

For more information on these and other cases, see: http://online.wsj.com/article/SB10001424052748703859304576307060330715004.html

While emergency room misdiagnoses usually happen because a physician misjudges a patient’s symptoms, in almost all cases of missed or delayed diagnoses, essential pieces of information weren’t available at the time the doctor made a decision.   This is largely due to poor doctor-nurse communication.  Hospitals have become more and more dependent on electronic communication, and as a result, when a doctor or nurse updates a patient’s record, he or she assumes the other looked at it.  This is a valid assumption.  However, several hospitals have implemented projects to improve communication including by way of face-to-face communication.  This could possibly create a new system for triaging patients.  In the Philadelphia area, Abington Memorial Hospital is moving patients immediately to beds to be seen by both a doctor and nurse to ensure both hear vital information, whereas Taylor Hospital uses nurse-doctor huddles to review and update patient data.

According to Laura Landro at the Wall Street Journal, who blogged “How Resolved Malpractice Claims Might Help Reduce Misdiagnosis in the E.R.” on May 10, 2011, several medical malpractice insurance companies and risk management services are encouraging hospitals to participate in these projects to increase precision in physician diagnoses.  In this blog post, emergency physicians say, although it doesn’t take into account the intensity and hustle of the emergency room “examining resolved claims is useful for preventing future errors and developing standards of care.”

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