Defensive Medicine Benefits

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

A study by the CDC showed that approximately 70 % of emergency department visits can be

Patients who request for their own doctors should have their wishes respected as a matter of a patient's rights. It does not matter whether those requests occur in the ER or during their hospitalization under the UCR hospitalists. These requests have been routinely ignored, or transmogrified into an ugly

The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another

Case management in the emergency department, constantly works to find the right data in a patient’s record to ensure that they have the correct insurance coverage and can be admitted or discharged at the appropriate time and place. Even when the smallest amount of essential information is not documented, this otherwise straight forward process turns into a scavenger hunt for who has seen the patient, interventions that were done and for what reasons, and at what time all of these things took place. ED case manager Veronica Kountz (personal communication, March 20, 2015) states that the inadequacy of documentation can lead to insurance companies not covering patient costs, which the hospital then has to absorb. Before a patient can be admitted or discharged, the right

There is no standard procedure for treatment of illness. The variation reflects inefficiencies and unnecessary costs. In order to reduce the variation in treatments through standardization of process known as Evidence Based Best Practice (EBBP) can ensure reduction in cost of treatment and ensure the quality of outcome. It is very difficult to enforce EBBP for example in an ER of a hospital a physician normally is allowed to work between 8 to 10 hours. If a patient is treated by one doctor who prescribes certain tests. After the shift is over, another doctor after looking at the patient advices some more tests. The first physician does not takes the responsibility of the second doctor’s action. This increases the cost of the treatment of the

A disturbing trend in emergency medicine research is developing due to a reduction in research dollars. Shrinking budgets for research are limiting funds that inform residents of ongoing studies. The result is that people are not aware that they might be subject to experimental medicine and do not have the choice to opt out if they so choose.

The filing of the complaint must be completed within 72 hours of the transfer (Sally Austin, 2011). As a result of this, it has been difficult to see whether or not EMTALA has truly been successfully implemented and effective (Sara Rosenbaum, 2012). Another disadvantage is that EMTALA only requires hospitals to treat “true emergencies”, which are subjective in nature. The last revisions in 2003 for EMTALA by policymakers and CMS limited EMTALA to only patients that arrived to the emergency department, not to other areas of the hospital, such as a doctor’s office appointment or outpatient surgery (Sara Rosenbaum, 2012). Another negative consequence of EMTALA that is not addressed by the law is that emergency department physicians can still be held liable and face malpractice issues by uninsured patients (Singer, 2014). There have been legislative proposals by members of Congress that are working to change this to include physicians as members of the Public Health Services, which would address these concerns (Singer, 2014). These hesitations by physicians has forced some hospitals to close their emergency departments in California to avoid these financial consequences of lawsuits (Friedman, 2011).

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

Defensive medicine has also contributed to the over-utilization of healthcare services. Providers tend to order unnecessary tests, medications, and procedures in order to evade malpractice

they must send them to another hospitals ED. Ambulances can drive around for unnecessary amounts of time trying to find a hospital with room in the emergency department for their victim. This can be scary for the victim. They present a huge health risk for patients seeking urgent medical attention. Ambulance diversions wouldn’t be an issue if overcrowding did not exist. Schull (2003) believes that ambulance diversion is driven by the boarding of patients and is not otherwise related to issues of staffing within the ED itself. (p.467-476)

Great post. The advantage of disseminating EBP knowledge, such as the use of chlorhexidine to prevent MRSA & VRE is huge. MRSA & VRE are some of the hospital acquired infection that is of huge cost to the hospitals because insurance companies will not pay for such treatment. In addition, the quality of care given to patients depends on how safe our patients entrusted to our care are (free of hospital acquired infection). I think the need to disseminate EBP knowledge should be encouraged to promote quality of care and reduce cost. In response, to your question about the use of PCAT, I would say that PCAT are overwhelmed because PCAT/patient ratio is higher than RN/patient ratio. Although, 2 hourly rounding may be adopted, I think patients’

Thus, emergency physicians cannot rely on earned trust or on prior knowledge of the patient's condition, values, or wishes regarding medical treatment. The patient's willingness to seek emergency care and to trust the physician is based on institutional and professional assurances rather than on an established personal relationship. Fourth, emergency physicians practice in an institutional setting, the hospital emergency department, and in close working relationships with other physicians, nurses, emergency medical technicians, and other health care professionals. Thus, emergency physicians must understand and respect institutional regulations and inter-professional norms of conduct. Fifth, in the United States, emergency physicians have been given a unique social role and responsibility to act as health care providers of last resort for many patients who have no other feasible access to care. Sixth, emergency physicians have a societal duty to render emergency aid outside their normal health care setting when such intervention may save life or limb. Finally, by virtue of their broad expertise and training, emergency physicians are expected to be a resource for the community in pre-hospital care, disaster management, toxicology, cardiopulmonary resuscitation, public health, injury control, and related areas. All of these special circumstances shape the

“Hospitals are not only required to care for emergency patients, but they also are required to do so in a timely fashion” (Pozgar, 2010, p. 272). “Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the emergency department. An on-call physician who fails to respond to a request to attend a patient can be liable for injuries suffered by the patient because of his or her failure to respond” (Pozgar, 2010, p. 271). Under the doctrine of Respondeat Superior, hospitals are also liable for the actions of physicians working or on-call in their emergency department.

Every one of us has relied on a medical professional at least a few times in our lives. When we get seriously ill, or suffer a serious injury, we put our health in the hands of doctors, nurses, and pharmacists, fully expecting to be treated with a certain degree of professionalism and safety. Unfortunately, sometimes the expected care is not given, or not given to the extent which the ailment requires. In these situations, we can feel blindsided, confused, even taken advantage of.