This case study was made available to MIEC through our partnership with CRICO. It was originally written by Margaret Janes, JD,RN, CRICO. Description A 41-year-old woman presented to the ED with a headache; she was treated and discharged within three hours with a diagnosis of migraine. Later the same day, she had an acute event. A CT revealed a subarachnoid hemorrhage from a ruptured aneurysm. Key Lessons Each provider owes it to the patient to make an independent assessment. Effective bias can narrow a clinician’s judgment and consideration of a patient’s complaints. Clinical Sequence A 41-year-old woman with a history...
This case study was put together by our partners at CRICO and was written by Katherine Zigmont, BS, RN, CPPS, CRICO Description A 34-year-old male suffered complications of untreated pyelonephritis, including sepsis and multiple amputations, after spending 17 hours in the Emergency Department (ED). Key Lessons Boarding of critically ill patients is associated with increased mortality Abdominal pain coupled with an elevated white blood cell count and fever elevates consideration of urgent testing/imaging Weekend and off shift resources, e.g., a radiologist to read a CT scan, cannot be underappreciated Trainees require vigilant supervision Direct communication between ordering providers and consultants...
The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 is a federal law aimed at ensuring public access to emergency medical services regardless of a patient's ability to pay for those services. The primary intent of EMTALA is to prevent instances of "patient dumping," in which hospitals refuse to treat uninsured patients or transfer them to other facilities without providing adequate medical evaluation and care. EMTALA imposes several requirements on Medicare-participating hospitals that offer emergency services, and physicians with staff privileges at those hospitals may also have individual obligations under EMTALA. Hospital Requirements When a patient arrives at a...
The ongoing wildfires in Los Angeles County are straining local healthcare resources as physicians and other providers care for patients who were directly injured in the fires and/or emotionally traumatized from the disaster, as well as displaced residents who need ongoing medical care. Local medical clinics, physician offices, and other healthcare facilities have been either destroyed in the fires or closed due to lack of access. Since the wildfires, several important temporary changes to laws and regulations at both the federal and state levels have been made to facilitate health care for those affected by the fires. On January 10th...
Diagnosis of Aortic Dissection Delayed by Mismanagement of Imaging Orders
This case study was made available to MIEC through our partnership with CRICO. It was written by Jack Hoffman CRICO Description A 60-year-old male seen in the ED for acute severe epigastric pain suffered a hypoxic brain injury and spinal paraplegia after mismanagement of imaging orders delayed the diagnosis of an aortic dissection. Key Lessons Instructions for patients who call with potentially life-threatening conditions should reflect the urgency (e.g., “get to the nearest ED, immediately”) Abnormal vital signs merit a higher ESI (emergency severity index). Diagnostic study orders should prioritize immediate life threats as well as the likelihood of possible...