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PubMed1989

Litigation against the emergency physician: common features in cases of missed myocardial infarction.

Adverse outcome data from two insurance companies were retrospectively studied to determine whether a constellation of clinical circumstances, data-gathering behaviors, or physician variables were common to cases of missed acute myocardial infarction (AMI) and, if so, to formulate quality assurance recommendations to decrease future occurrences of misdiagnosis. We studied AMI because missing this diagnosis accounts for the highest dollar losses in emergency department malpractice cases. Our study group consisted of 65 patients with undiagnosed AMI seen in EDs between 1982 and 1986. Univariate differences between undiagnosed cases and correctly diagnosed concurrent controls were analyzed using Student's t test and chi 2 analysis. Insurance losses for our cases averaged $113,806 +/- $178,330 (SD). Compared with concurrent controls, study patients were significantly younger, presented more atypically, and had fewer ECGs that were diagnostic of AMI. Undiagnosed patients were evaluated by physicians who documented less detailed histories, misread more ECGs, had less ED experience, and admitted fewer patients to the hospital. Preventive strategies are outlined.

Diagnostic Errors↗
PubMedDate not supplied

The clinical record: recognizing its value in litigation.

Documenting completely and accurately is standard nursing practice, yet many nurses do not seem to understand that proper documentation is crucial to the communication and critical decision-making necessary to meet patients' needs. In fact, failure to document can have lethal consequences. Documentation of intake and output (I & O) is used here as an example of the evidence attorneys and nurse experts look for in the clinical record of elders. From exhibits of I & O records, juries can determine if nurses collected sufficient data for appropriate decision-making to protect the patient from harm. Readers are invited to test themselves to determine if their own I & O documentation meets acceptable standards of nursing practice. If readers find areas for improvement, self-study or group in-services can be held to improve the documentation and use of these data.

Benchmarking↗