EREM: Pitfalls and Perils of Emergency Department Discharge Instructions

In the emergency department (ED), failure to comply with discharge instructions has been associated with an increased rate of adverse outcomes for patients. ^1,2 There is tremendous variability in the information that is provided to patients in discharge paperwork. In some EDs, a simple handwritten discharge note is given to the patient, while in others, extensive, diagnosis specific pre-created instructions are provided to patients at time of discharge. To improve patient outcomes and reduce their medicolegal risk, providers must recognize pitfalls associated with discharge instructions and include two key elements as a part of all discharge paperwork.

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By Matthew DeLaney, MD|2016-11-11T19:37:15-08:00Jul 6, 2015|Expert Peer Reviewed (Clinical), Medicolegal|

4 Pitfalls of Bedside Ultrasonography During First Trimester Pregnancy

One of the more common indications for the use of bedside ultrasound (US) is to evaluate patients who present to the emergency department (ED) with pain or bleeding during the first trimester of pregnancy. When performing this study, providers should be aware of several potential pitfalls that pose significant risk to both the patient and the provider.

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By Brian Bauerband, MD|2019-02-19T18:51:28-08:00Apr 13, 2015|Expert Peer Reviewed (Clinical), Ob/Gyn, Ultrasound|

High risk back pain: Spinal Epidural Abscess

Spinal epidural abscess (SEA) is a rare but potentially catastrophic cause of back pain. Classically these patients are described as having back pain, fever, and clear neurologic deficits. In reality, patients often present with less obvious symptoms which often leads to a delay in diagnosis. Missed cases of SEA are a source of significant risk to both the patient and the provider. To improve outcomes and minimize risk, providers must identify and promptly evaluate patients who are at increased risk of developing a SEA.

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By Matthew DeLaney, MD|2016-11-12T09:28:24-08:00Sep 25, 2014|Infectious Disease, Orthopedic|

High risk back pain: Cauda Equina Syndrome (EREM)

Cauda equina syndrome (CES), which occurs due to compression of the distal lumbar and sacral nerve roots, is a potentially devastating cause of back pain. CES is often missed on the patient’s initial visit which can lead to significant neurologic compromise in a matter of hours [1]. To improve patient outcomes and minimize medicolegal risk, providers need to understand the limitations of the history and physical and carefully consider the diagnosis of CES in any patient with back pain.

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By Matthew DeLaney, MD|2016-12-20T11:19:57-08:00Jun 9, 2014|Medicolegal, Orthopedic|

Beware of fluoroquinolones: You, your patient, and the FDA

Fluoroquinolones are a widely used class of antibiotic that are effective in treating a wide variety of infections. Despite their popularity there is increasing concern regarding to the potential complications associated with these agents. In 2008, the U.S. Food and Drug Administration (FDA) issued a black box warning involving fluoroquinolone use and an increased risk of tendon rupture. More recently in 2013 the FDA released another warning regarding the risk of peripheral neuropathy and required additional warnings to be added to the drug labels [1].

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By Matthew DeLaney, MD|2017-03-05T14:18:39-08:00Apr 7, 2014|Medicolegal, Tox & Medications|

Is the Patient Sober? Clinical Sobriety versus Blood Alcohol Concentration

There is significant practice variability when providers are asked to determine if a patient is intoxicated. Some providers will evaluate a patient to determine if a patient is “clinically sober”, while other providers will rely on a patient’s blood alcohol concentration (BAC) to evaluate a patient’s level of intoxication. There is very little data to suggest that either approach is superior; however, both practice patterns have significant limitations and carry a certain degree of medicolegal risk.

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By Matthew DeLaney, MD|2016-11-11T19:19:30-08:00Mar 6, 2014|Medicolegal, Tox & Medications|

AMA: 2 high risk myths and misconceptions

Patients who leave the emergency department against medical advice (AMA) are at an increased risk of having a bad medical outcome, and can be a source of significant medicolegal risk to providers. Earlier we reviewed eight elements to address when signing a patient out AMA. There are two common myths regarding patients who leave AMA that can complicate an already difficult situation.

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By Matthew DeLaney, MD|2016-11-11T19:18:19-08:00Feb 10, 2014|Medicolegal|

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