Emergency Medicine

Apr 01, 2022
Analysis of Cerebrovascular Accidents and Malpractice Claims
Shelley Rizzo, MSN, CPHRM, Senior Patient Safety Risk Manager, The Doctors Company
Because cerebrovascular accidents can happen at any time and in any location, it is imperative that all members of the healthcare team are able to recognize and respond to symptoms in a timely manner.

Nov 29, 2021
The Evolving Landscape of Diagnostic Errors—Challenges and Opportunities
David E. Newman-Toker, MD, PhD, Professor of Neurology, Ophthalmology, and Otolaryngology, and Director, Armstrong Institute Center for Diagnostic Excellence, Johns Hopkins University School of Medicine
Internationally recognized healthcare leader David E. Newman-Toker, MD, PhD, presents a compelling case example and shares key insights into transforming diagnostic accuracy.
From The Doctor’s Advocate

Nov 15, 2021
To Measure and Reduce Diagnostic Error, Start With the Data You Have
David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and TDC Group; Senior Vice President, Healthcare Risk Advisors
Chief Medical Officer David L. Feldman, MD, MBA, FACS, recaps important recommendations by diagnostic safety expert Hardeep Singh, MD, MPH, for measuring and reducing diagnostic error.
From The Doctor’s Advocate

Professional Education
Clinical Presentations Cause Delays: Failure to Diagnose Myocardial Infarction
In reviewing closed malpractice claims, The Doctors Company identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
0.5 credit

Professional Education
Delayed Diagnosis of Stroke
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke.
0.5 credit

Video Oct 28, 2021
What Clinical Support Tools Can Help Emergency Department Physicians Reduce Diagnostic Errors?
Emergency department systems and processes can increase or reduce the risk of diagnostic error. But instead of simply asking clinicians to work harder or smarter, what’s needed is the creation of a system of care that optimizes their ability to think and carry out an efficient work-up of a patient. Learn more from Jacqueline Ross, PhD, RN, CPAN, our coding director.

Jul 27, 2021
Burnout from COVID-19: How Healthcare Professionals Can Manage Stress
Robert Morton, MAS, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company, and Jennifer Perla, RN, LPC-S, Medical Advantage, Part of TDC Group
During the COVID-19 pandemic, healthcare professionals have shown great courage by adapting to unprecedented conditions and laboring tirelessly to provide patient care. But these extreme circumstances have frequently led to burnout and even more serious consequences, such as suicide.

Professional Education
The Need for Close Monitoring in Hyponatremia: Osmotic Demyelination Syndrome
In reviewing closed malpractice claims, The Doctors Company identified mismanagement of sodium levels during correction of severe hyponatremia as a serious problem that can result in catastrophic permanent neurological injury due to osmotic demyelination syndrome (also known as central pontine myelinolysis). This article highlights the importance of close monitoring of sodium levels during correction of severe hyponatremia, with a slow and controlled pace of sodium correction. Contributing factors discussed include clinical judgment with regard to rate of rise of sodium levels, patient monitoring, choice of practice setting, and communication between providers, especially at points of transition in care.
0.5 credit

Jun 18, 2021
Study of Emergency Department Diagnosis Case Type Malpractice Claims: Abstract
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management
A study of diagnosis-type closed medical malpractice claims from care that occurred in the ED from 2014 through the second quarter of 2019 using closed coded claims from The Doctors Company.

Professional Education
Dictation Errors in the Emergency Department
The Doctors Company identified dictation errors as a significant patient safety risk factor. The following case highlights the importance of timely recognition of dictation errors to ensure accuracy of the permanent electronic health record (EHR). This is particularly important when using a voice recognition program to document encounters in the busy emergency department. In this case, the voice recognition system was Dragon Direct Voice Recognition Program.
0.5 credit

Mar 29, 2021
Is Your Patient a Victim of Human Trafficking?
Amy Wasdin, RN, CPHRM, Patient Safety Risk Manager II, The Doctors Company
Although trafficking victims rarely find opportunities to interact with others, a visit to a physician or dental practice may provide an opportunity for a victim to receive help. Learn to recognize the signs of human trafficking and know what steps to take.

Jan 28, 2021
Missed Diagnosis of Spinal Epidural Abscess
David B. Troxel, MD, Medical Consultant to The Doctors Company
Spinal epidural abscess requires prompt diagnosis and treatment to prevent serious neurological complications.

Jan 08, 2021
Communication Breakdowns Lead to Missed Spinal Epidural Abscess: Case Study
Michelle Swift, JD, RN, Senior Patient Safety Risk Manager, The Doctors Company
Experts weigh in on this case involving poor communication and failure to diagnose spinal epidural abscess.

Dec 02, 2020
The Role of Pretest Probability in the Evaluation of Suspected Venous Thromboembolism
Howard Marcus, MD, FACP
The presenting signs and symptoms of venous thromboembolism are often vague and nonspecific, and early diagnosis—often crucial to the patient’s outcome—may be challenging.
From The Doctor’s Advocate

Professional Education
Spotlight on Diagnosing PE/DVT
The overall incidence of venous thromboembolism (VTE) —including both deep vein thrombosis (DVT) and pulmonary embolism (PE) —is one case per 1000 patient years. Accurate and timely diagnosis of VTE can be improved with the use of diagnostic guidelines such as Wells criteria and scoring for both DVT and PE.
0.5 credit

Professional Education
Cauda Equina Syndrome: A Failure to Diagnose
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when patient assessments are incomplete, having a narrow diagnostic focus, or diagnostic test issues. Other factors that hinder timely diagnoses include failure to appreciate signs and symptoms, lack of consults, and failure to respond to repeated patient concerns/symptoms.
0.5 credit

Aug 25, 2020
Distracting Devices in Healthcare: Malpractice Implications
Shelley Rizzo, MSN, CPHRM, Senior Patient Safety Risk Manager
Digital distraction in healthcare is a threat to patient safety and physician well-being. Personal electronic devices can create a digital distraction so engaging that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients.

Professional Education
Making an Informed Consent an Informed Choice: Training for Healthcare Professionals
This activity, designed for doctors, nurses, and other providers, examines problems with the process of healthcare informed consent. It describes the principles of informed consent and highlights the benefits gained from a good informed consent process.
2.3 credits

May 13, 2020
Did Emergency Department Provider Fatigue Contribute to This Patient’s Death?
Lisa McCorkle, MSN, MBA, Senior Patient Safety Risk Manager, Department of Patient Safety and Risk Management
Provider fatigue and the rush to get things done when staffing levels are inadequate can lead to mistakes and poor outcomes for patients.

Dec 01, 2019
Dilaudid-Related Morbidity and Mortality from Respiratory Depression
Howard Marcus, MD, FACP, Chairman, Texas Alliance for Patient Access
Patient safety organizations and the FDA are focusing on ways to reduce patient harm from opioids.

Aug 27, 2019
Electronic Health Records Continue to Lead to Medical Malpractice Suits
Darrell Ranum, JD, Vice President of Patient Safety and Risk Management
We analyzed 216 medical malpractice claims that closed from 2010 to 2018 in which EHRs contributed to patient injury. The pace of these claims grew, from a low of seven cases in 2010 to an average of 22.5 cases per year in 2017 and 2018. As EHRs approach near-universal adoption, they may become a more prevalent source of patient safety risk.

Mar 20, 2019
Study of Malpractice Claims Involving Children
Darrell Ranum, JD, CPHRM, Vice President, Patient Safety and Risk Management
The Doctors Company analyzed 1,215 claims filed on behalf of pediatric patients that closed from 2008 through 2017. The study is based on the claims filed against physicians in 52 specialties and subspecialties and includes an overview of the most common types of claims, expert insights into the specific elements that led to patient injury, and risk mitigation strategies.

Dec 26, 2018
Mitigating the Risk of Osmotic Demyelination Syndrome
Howard Marcus, MD, FACP
Insights into managing patients with severe hyponatremia.
From The Doctor’s Advocate

Video Sep 04, 2018
What to Expect from Litigation: Dr. Gupta's Perspective
Adverse outcomes sometimes occur even when physicians follow the standard of care and do all they can for their patients. This video, the third in a series showcasing actual claims experiences, highlights the stress and worry that accompany a medical malpractice lawsuit. Emergency medicine physician Dr. Malkeet Gupta recounts how being sued for medical malpractice affected him.

Mar 26, 2018
Nurse Practitioner Closed Claims: Risk Mitigation Strategies
Strategies to help nurse practitioners and physicians prevent patient injuries.
From The Doctor’s Advocate

Dec 07, 2017
Teamwork Saves Lives in Bronx-Lebanon Hospital Shooting
Shelley Rizzo, MSN, CPHRM, Patient Safety Risk Manager, The Doctors Company, and Steven J. Weintraub, MD, Chief of Risk Management, North American Partners in Anesthesia
Teams pull together to save lives and provide support during a deadly hospital shooting.
From The Doctor’s Advocate

Video Sep 12, 2017
Emergency Medicine: Innovations in Patient Safety
Roneet Lev, MD, FACEP, chief of the emergency medicine department at Scripps Mercy in San Diego, California, describes changes her department made to improve patient safety based on the data and recommendations in The Doctors Company’s Emergency Medicine Closed Claims Study. The study identified the need for rapid recognition of stroke patients and treatment for tissue plasminogen activator (tPA).

Mar 16, 2017
Analysis of Medication-Related Claims from The Doctors Company
David B. Troxel, MD, Medical Director, Board of Governors
Dr. David Troxel reviews 1,770 closed by The Doctors Company in which patient harm involved medication factors.
From The Doctor’s Advocate

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