Closing the Loop: Strategies to Minimize Risk in the Emergency Department

An analysis of almost 12,000 medical malpractice claims against emergency departments found 70 percent are closed without a payment to the plaintiff.  That same study identified the top two categories of claims as errors in diagnosis (37 percent) and no identified error (18 percent).1

Other research has found the average indemnity payout for an alleged misdiagnosis can be substantial: $408,166 for pulmonary embolism claims, $443,471 for meningitis claims and $619,517 for stroke claims.2 

Presently, significant attention is paid to assessment and treatment of patients who present in the ED, and numerous protocols and tools are available to aid providers in these areas.  Often overlooked is a consistent, structured process for following up with patients discharged from the ED. Establishing a call-back program to contact all discharged patients, or select groups of patients, is a recommended risk mitigation practice.3 The process of contacting patients may be automated in part with patients being contacted via text or email and then by phone if the patient does not reply electronically.4

Implementing a formalized call-back program for all patients discharged from the ED offers several risk mitigation benefits:

  • It provides for identification and immediate follow-up with any patients who report their condition has worsened.
  • It identifies any need to refresh instructions, and it also affords the opportunity to answer any questions that may have arisen from patients or their caregivers.
  • It allows patients to rate their ED experience, including their satisfaction with the nursing staff, ED physician and other facets of the care experience, along with giving the organization the opportunity to respond to any concerns voiced by the patient.
  • It documents positive responses to improvement in the patient's condition, satisfaction with care and understanding of any instructions to follow up with other providers or instructions concerning post-treatment care. Documentation of those affirmative responses may be useful in mitigating any future claims.

Improving patient satisfaction may also have a risk mitigation effect. Low patient satisfaction scores have been found to correlate well with increased malpractice litigation activity.5 Patient call-back programs may have a risk mitigation effect because they have been found to both improve patient satisfaction and increase the likelihood of the patient recommending the ED to others.6,7

Timothy Kelly is a director of Standard Register Healthcare, a leader in managing patient-centric information and communications. He operates out of the Dialog Medical subsidiary, which specializes in enhancing patient engagement and automating informed consent processes.

1Brown TW, McCarthy ML, Kelen GD, Levy F. An epidemiologic study of closed emergency department malpractice claims in a national database of physician malpractice insurers. Acad Emerg Med. 2010;17(5):553-60. 

2Iglarsh H, ed. Emergency department liability: sound risk control strategies can reduce misdiagnosis. VantagePoint. Chicago: CNA HealthPro; 2008(3):2.

3Reduce your risks in the emergency department. Oakland: Medical Insurance Exchange of California. 2005:12.

4Rodak S. Post-Discharge Follow-Up Isn't Just for Hospitalizations: The Value of Contacting ED Patients. Becker's Infection Control & Clinical Quality. March 7, 2013. Available at: https://www.beckershospitalreview.com/quality/post-discharge-follow-up-isnt-just-for-hospitalizations-the-value-of-contacting-ed-patients.html. Accessed April 1, 2014.

5Fullam F, Garman AN, Johnson TJ, Hedberg EC. The use of patient satisfaction surveys and alternative coding procedures to predict malpractice risk. Med Care. 2009;47(5):553-9.

6Patel PB, Vinson DR. Physician e-mail and telephone contact after emergency department visit improves patient satisfaction: a crossover trial. Ann Emerg Med. 2013;61(6):631-637.

7Ellsworth MA, Anderson KR, Hall DJ, Freese DK, Lloyd RM. Acute liver failure secondary to niacin toxicity. Case Rep Pediatr. 2014;2014:692530.

More Articles on Emergency Department Management:
ACEP: Physicians Report Increased ER Visits Since PPACA Implementation
Using Data to Measure ED Performance
Most ED Super Users Addicted to Drugs, Study Finds

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