Malpractice claims against emergency physicians in Massachusetts: 1975–1993

Karcz, Anita; Korn, Robert; Burke, Mary C.; Caggiano, Richard; Doyle, Michael J.; Erdos, Michael J; Green, Errol D; Williams, Kenneth L.

doi:10.1016/s0735-6757(96)90044-3

Cited by 124 publications

(46 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Between 2 and 5% of patients with acute coronary syndrome (ACS) may be discharged with an incorrect non-ACS diagnosis and no further follow-up, 3,4 leading to adverse patient outcomes and medicolegal costs. 5 As initial electrocardiogram (ECG) and biomarker results may lack sensitivity, further investigation is usually required. Although most patients are at low risk, many centres attempt to maximize diagnostic sensitivity by applying comprehensive ruleout protocols involving prolonged monitoring, serial cardiac investigations, provocative or invasive testing, and often admission to observation or coronary care units [6][7][8] ; a recent study from Minnesota reported that nearly all chest pain patients were admitted to hospital.…”

Section: Ré Sumémentioning

confidence: 99%

Development and validation of a prediction rule for early discharge of low-risk emergency department patients with potential ischemic chest pain

Scheuermeyer

Wong

et al. 2014

CJEM

View full text Add to dashboard Cite

Objectives: Current guidelines emphasize that emergency department (ED) patients at low risk for potential ischemic chest pain cannot be discharged without extensive investigations or hospitalization to minimize the risk of missing acute coronary syndrome (ACS). We sought to derive and validate a prediction rule that permitted 20 to 30% of ED patients without ACS safely to be discharged within 2 hours without further provocative cardiac testing. Methods: This prospective cohort study enrolled 1,669 chest pain patients in two blocks in 2000-2003 (development cohort) and 2006 (validation cohort). The primary outcome was 30-day ACS diagnosis. A recursive partitioning model incorporated reliable and predictive cardiac risk factors, pain characteristics, electrocardiographic findings, and cardiac biomarker results. Results: In the derivation cohort, 165 of 763 patients (21.6%) had a 30-day ACS diagnosis. The derived prediction rule was 100.0% sensitive and 18.6% specific. In the validation cohort, 119 of 906 patients (13.1%) had ACS, and the prediction rule was 99.2% sensitive (95% CI 95.4-100.0) and 23.4% specific (95% CI 20.6-26.5). Patients have a very low ACS risk if arrival and 2-hour troponin levels are normal, the initial electrocardiogram is nonischemic, there is no history of ACS or nitrate use, age is , 50 years, and defined pain characteristics are met. The validation of the rule was limited by the lack of consistency in data capture, incomplete follow-up, and lack of evaluation of the accuracy, comfort, and clinical sensibility of this clinical decision rule. Conclusion: The Vancouver Chest Pain Rule may identify a cohort of ED chest pain patients who can be safely discharged within 2 hours without provocative cardiac testing. Further validation across other centres with consistent application and comprehensive and uniform follow-up of all eligible and enrolled patients, in addition to measuring and reporting the accuracy of and comfort level with applying the rule and the clinical sensibility, should be completed prior to adoption and implementation. RÉ SUMÉObjectif: D'aprè s les lignes directrices actuelles, on ne peut renvoyer du service des urgences (SU) les patients qui souffrent de douleurs thoraciques de nature probablement isché mique mais qui connaissent un faible risque de maladie cardiaque sans d'abord leur faire subir une exploration approfondie ou sans les hospitaliser afin de ré duire le plus possible le risque de syndrome coronarien aigu (SCA) passé inaperç u. Aussi avons-nous tenté d'é laborer et de valider une rè gle pré visionnelle qui permettrait de renvoyer en toute sé curité de 20 à 30% des patients ne souffrant pas d'un SCA au cours des 2 heures suivant leur arrivé e au SU, et ce, sans leur faire subir d'autres é preuves d'exploration cardiaque. August 20, 2012) suggest over 600,000 annual ED visits. Between 2 and 5% of patients with acute coronary syndrome (ACS) may be discharged with an incorrect non-ACS diagnosis and no further follow-up, 3,4 leading to adverse patient ...

show abstract

Section: Ré Sumémentioning

confidence: 99%

Development and validation of a prediction rule for early discharge of low-risk emergency department patients with potential ischemic chest pain

Scheuermeyer

Wong

et al. 2014

CJEM

View full text Add to dashboard Cite

show abstract

“…In addition to direct medical costs from the acute episode, other factors include the costs of long-term sequelae; the costs to society of meningococcal outbreaks, including the outbreak investigation, providing antibiotic chemoprophylaxis, and providing a meningococcal vaccine; the costs of litigation (192,193,380); and the cost of disruption in schools, other institutions, and the community. In addition, cost-benefit analyses of meningococcal conjugate vaccines have generally failed to take the potential substantial impact of herd immunity into account, a major limitation given the demonstrated impact of conjugate vaccines on the incidence of disease in unimmunized persons (3, 224,280,384).…”

Section: Cost-effectivenessmentioning

confidence: 99%

Prospects for Vaccine Prevention of Meningococcal Infection

2006

View full text Add to dashboard Cite

SUMMARY Neisseria meningitidis is the leading cause of bacterial meningitis in the United States and worldwide. A serogroup A/C/W-135/Y polysaccharide meningococcal vaccine has been licensed in the United States since 1981 but has not been used universally outside of the military. On 14 January 2005, a polysaccharide conjugate vaccine that covers meningococcal serogroups A, C, W-135, and Y was licensed in the United States for 11- to 55-year-olds and is now recommended for the routine immunization of adolescents and other high-risk groups. This review covers the changing epidemiology of meningococcal disease in the United States, issues related to vaccine prevention, and recommendations on the use of the new vaccine.

show abstract

“…Because of the importance of missed fractures to ED malpractice claims, and the centrality of imaging to emergency diagnoses, radiographic interpretation is a clear topic for study in EM. 57 It is also a Joint Commission requirement.…”

Section: System-level Approachesmentioning

confidence: 99%

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Schenkel

2000

Academic Emergency Medicine

135

View full text Add to dashboard Cite

Abstract. An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.

show abstract

Malpractice claims against emergency physicians in Massachusetts: 1975–1993

Cited by 124 publications

References 13 publications

Development and validation of a prediction rule for early discharge of low-risk emergency department patients with potential ischemic chest pain

Development and validation of a prediction rule for early discharge of low-risk emergency department patients with potential ischemic chest pain

Prospects for Vaccine Prevention of Meningococcal Infection

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Contact Info

Product

Resources

About