Blog & Articles
A Note From the Editor: Spring 2025
April 1, 2025
[4 min read] Welcome back to The Sullivan Group’s Spring Newsletter! It’s been a while—five years, to be exact—since our last edition. A lot has changed, and it's time for TSG to re-engage and bring emergency medicine risk and safety back into focus. Source: Hubspot
Case: Risks of Misdiagnosed Orthopedic Injuries
March 31, 2025
[7 min read] Editor’s Note: The TSG course on high-risk orthopedic injuries has been updated. The following includes two case reviews and a summary of important issues from that course. High Risk Orthopedic Injuries Orthopedic injuries, particularly those involving the extremities, carry a significant risk of complications if not promptly and accurately diagnosed. Conditions such as compartment syndrome, open fractures, and joint dislocations often present subtly, especially in early stages, and require a
Case: Recognizing Stroke Mimics and Chameleons
March 24, 2025
[5 min read] Editor’s Note: The TSG course on Stroke Mimics: Pearls and Pitfalls has been updated, one of several stroke/TIA offerings. The following includes a case review and a summary of important issues from that course. Timely and accurate recognition of neurologic deficit and stroke remains at the forefront of emergency medicine risk management and patient safety. Stroke Mimics: Pearls and Pitfalls Accurate recognition and management of stroke are critical not only for
Case: The Critical Role of POCUS in Modern Clinical Practice
March 17, 2025
[3 min read] Editor’s note: TSG has created a new on-line course with a spotlight on Point of Care Ultrasound (POCUS). Emergency physicians and other specialties embracing this technology should be aware of important current issues related to POCUS. What follows is a summary and case example from the course. POCUS: Evolving Standards of Care Point-of-care ultrasound (POCUS) is rapidly transforming clinical practice by bringing real-time diagnostic imaging to the
Patient Safety and Nurse Turnover Rates
September 3, 2024
The shortage of nursing professionals is a growing global crisis that significantly impacts patient safety and healthcare delivery systems. Emergency departments (EDs) are particularly impacted, as there are not many nurses still working in EDs who have more than a few years of experience. The importance of an experienced and effective nursing team cannot be overstated both in and outside of the ED. The nursing shortage has a direct impact on patient safety, so this
Hospital Triage Assessment: An Under-Appreciated Risk?
August 12, 2024
Triage is an essential part of any busy emergency department (ED), but it is often undervalued. While triage is not designed to determine the cause of a patient’s symptoms, it prioritizes the patient’s need to be seen by a provider. EDs often assume (possibly erroneously) that triage assessments are being performed correctly or that any errors in triage can be corrected when the medical screening is done. Both assumptions can lead to serious adverse patient
How Disruptive Behavior in Healthcare Impacts Patient Safety
June 8, 2024
Surgery Is a Team Sport Source: Hubspot
10 Considerations for Recognizing Stroke Mimics
June 6, 2024
Acute ischemic stroke affects about 800,000 patients a year in the U.S.; 600,000 of these cases are a first stroke. Stroke is a leading cause of permanent cognitive and function-limiting disability, and it ranks fifth among all causes of death. Source: Hubspot
Improving Nurse Retention & Job Satisfaction
June 3, 2024
What does your organization’s employee satisfaction survey really tell you about how staff feel about their roles/jobs? Source: Hubspot
Case: A Nurse's Role in Preventing Diagnostic Error
May 14, 2024
Despite almost two decades of attention and study, diagnostic error continues to be a main issue in healthcare, affecting an estimated 12 million people each year and causing harm in one-third of those cases. Source: Hubspot
Diagnostic Error: Chaos or Conquerable?
May 7, 2024
Effective solutions to combat diagnostic error exist today. Why haven't more institutions implemented programs with a focus on diagnostic error reduction? Source: Hubspot
Clinical Documentation and Patient Safety: We’re on a Slippery Slope
April 22, 2024
[9 MIN READ] Remember paper T sheets? Your patient has back pain, so you grab a paper T sheet from the anatomical rack, walk into the exam room, get your history, make some circles and slashes, and your history and physical is all but complete by the time you get back to your desk. Write in (remember writing?) some MDM and ‘ba-da-boom’, the chart is done. The focus was
Situation Critical: The Discharge of Patients with Very Abnormal Vital Signs
April 15, 2024
[6 MIN READ] The overwhelming majority of malpractice lawsuits in emergency medicine and other acute care venues involve the failure to diagnose. In most cases, these patients are discharged home where the missed diagnosis results in an adverse outcome or death. Fortunately, the patient “bounces back” in some cases, creating another opportunity to make the right diagnosis. Source: Hubspot
First Impressions are Critical to Patient Experience
April 8, 2024
[4 MIN READ] All of us experience a never-ending number of first impressions. Consider that first visit to a restaurant that was highly recommended by friends. After being seated, five or ten minutes go by without a server coming to the table. When the server finally arrives, they seem distracted with no discernible facial expression. How does this indifference make you feel? Or what about the flight attendant who treats you like
A Comprehensive Initiative To Improve Maternal Health
October 26, 2021
A steady increase in maternal mortality and morbidity in the U.S. prompted a comprehensive, collaborative response by the federal government and leading medical organizations focused on maternal health to improve outcomes. The Prevention of Maternal Death Act of 2018 directed DHS to develop programs that support the states in their work to save and sustain the health of mothers during pregnancy, childbirth, and in the postpartum period; to eliminate disparities in
Onboarding New Triage Nurses: A New Strategy For an Old Challenge
September 20, 2021
Challenges in a COVID World Covid-19 has brought to the forefront not only challenges in what to provide as optimal treatment but also a very unique challenge of who will provide it. Nurses are consistently the “most trusted” workforce across the globe.(1) This disease and its resulting pandemic have created a barrier to a few of the foundational blocks of nursing training at a time when it
Mitigating the Consequences of Burnout, Medical Errors, and Liability
September 7, 2021
In 2019, the World Health Organization categorized burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. While burnout was a concern before COVID-19, its onset has exacerbated the problem. According to an ACEP October 2020 poll, 87% of emergency physicians reported feeling more stressed since the start of the pandemic, and 72% reported experiencing more burnout on the job. On
Honoring Tom Syzek and Introducing Stassia Sullivan
September 3, 2021
I want to take a collective pause with you for a moment to recognize a very special individual in The Sullivan Group’s world, Dr. Tom Syzek. Tom has decided to step down from his position as TSG’s VP of e-Learning. I hesitate to say retire because Tom has a long list of things that will keep him busy, including swimming across Tampa Bay regularly in support of our veterans, long treks
Case: A Nurse’s Role in Preventing Diagnostic Error
August 3, 2021
Despite almost two decades of attention and study, diagnostic error continues to be a main issue in healthcare, affecting an estimated 12 million people each year and causing harm in one-third of these cases. The most comprehensive literature on this topic comes from “Improving Diagnosis in Health Care,” in which the first recommendation is to “facilitate more effective teamwork in the diagnostic process among health care professionals,
Using Telemedicine and Self-Monitoring to Safely Provide Prenatal Care to COVID-19 Patients
June 2, 2021
Updated: May 27, 2021 The emergence of the COVID-19 pandemic caused by SARS-CoV-2, a highly transmissible virus that can be spread by asymptomatic people, requires providers to make innovative changes in how patients are seen and treated in the ambulatory setting. Prenatal care requires frequent face-to-face visits, so it is particularly challenged to adapt to protect patients, providers and office staff. Ultrasound testing and fetal monitoring
COVID & Burnout: The MAACU Effect
May 18, 2021
[5 MIN READ] Before the COVID pandemic, the medical community in general, and physicians in particular, were dealing with and continue to deal with a pandemic of its own: Burnout. In 2019, burnout was categorized as a disease by the WHO. It is characterized as: “…a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” There are 3 dimensions of burnout:
Treatment for Pregnant COVID-19 Patients Not Requiring Hospitalization
May 11, 2021
Updated: April 30, 2021 Pregnant women who have known or suspected COVID-19 infection need to be evaluated quickly to determine the severity of their symptoms and if they have risk factors that put them at risk for severe disease. New data on the outcomes for pregnant women have shown that pregnancy is a risk factor for increased severe mortality and morbidity; for example, respiratory distress requiring intubation and admission to
March 19, 2021
In January 2020, the first case of the novel virus known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), responsible for COVID-19 disease, was found in the United States. Since that time, there have been 6 major vaccines developed to prevent infection with this virus. However, none of the original trials included pregnant women. Three of these vaccines – Moderna, BioNTech-Pfizer and Johnson
Case: When Is It More Than Just Back Pain?
December 18, 2020
History A 25-year-old man presented to the ED with the chief complaint of low back pain. The pain onset gradually about 10 days prior, days after he lifted some furniture. The pain was described as dull and constant, with an intensity of level 7 out of 10 and getting worse in the past few days. He also had milder pain in the mid-back. Nothing seemed to make the pain
Case: Complicated Angiogram Reveals VEDS Diagnosis
September 17, 2020
It’s estimated that between 3,000 and 8,000 people in the U.S. have Vascular Ehlers-Danlos Syndrome (VEDS), although many are undiagnosed. Because 50% of those with the condition do not have a family history, the road to diagnosis and expert care can be long. Many individuals with VEDS are not diagnosed until they have a life-threatening event, and 80% of VEDS patients will experience a major medical event by age 40; too many are diagnosed during autopsy. The
Triage Competency Checklist: Onboarding a New Nurse to Triage
August 19, 2020
[6 MIN READ] The national nursing shortage makes recruiting and retaining quality nursing staff extremely competitive. While facilities traditionally might have required 3-5 years of emergency department (ED) experience before training a nurse for triage, the lack of resources has forced some organizations into reducing the requirement to one year or less. As this requirement decreases, it is increasingly critical to have a well-defined onboarding path for
Anchoring: A Common Cause of Diagnostic Error
June 29, 2020
[8 MIN READ] Why was the diagnosis really missed? In my previous position as Manager of Risk, Claims & Insurance for our physician group, the available methods of error analysis never satisfied my quest for the ultimate answer to this recurrent question in any given case. The majority of our group practice was emergency medicine; our claims data mirrored the national trends showing that most claims were “diagnosis-related,” which contained the allegation that a clinician
June 16, 2020
[4 MIN READ] Every day, ED physicians, physician assistants, nurse practitioners and nurses are confronted with pediatric patients suffering from infections. Thankfully, most are self-limited respiratory or gastrointestinal viral infections. Symptomatic and supportive care may be necessary, but antibiotics are not usually indicated; minor infections such as otitis media, impetigo, pharyngitis and uncomplicated urinary tract infections usually respond well to either oral antibiotics or a single parenteral dose of an antibiotic. When treating an
Increasing Hospital Profitability by Improving Physician Engagement
May 27, 2020
7 minute read It appeared to be a typical, run-of-the-mill board meeting at Hospital System “X.” Patient admissions had been slowly on the rise; healthcare teams seemed to be handling the increasing demand for services as the hospital facility continued to display an inviting appearance. Early in the meeting, the hospital CFO presented the data requested by board members; suddenly things took a dramatic turn. Several months of data had revealed that a
7 Steps to Improving Patient Experience
May 12, 2020
[4 MIN READ] Every patient – regardless of the time of day or department to which they present – needs to encounter a high-quality experience. Improving patient experience and ensuring its consistency involves reducing the variability between departments, clinicians and shifts. To achieve this high goal, you need to get buy-in from the entire clinical community – an effort led by clinicians for clinicians to help all truly understand and buy into the mission and
April 13, 2020
[8 MIN READ] We are all fallible. Despite their best efforts, physicians, nurses, other healthcare workers, and indeed all humans, make errors. It is an essential component of our being. It is widely accepted that a systems approach to error prevention can counteract this fallibility. Nonetheless, errors do occur. These failures can often be explained by the “Swiss Cheese Model” of error. Multiple processes are designed to prevent a type of error. Each individual process
Obstacles to Implementing Emergency Department Triage Practice
March 31, 2020
After investing in an ongoing triage training program, some emergency department (ED) managers and educators become frustrated due to gaps in the application of that education. The goal of triage is to rapidly identify and sort patients to ensure they receive the appropriate care in the right amount of time. Updated triage practice protocol and ongoing triage training helps ensure optimal patient triaging. Implementing changes though does not always come easily., especially for those who have
Minimizing Spread of COVID-19 in the Obstetrics Unit
March 20, 2020
[9 MIN READ] Updated: March 18, 2020 Working on the front lines of an obstetric unit is fraught with vulnerability and uncertainty during these early stages of the unprecedented COVID-19 pandemic. Your obstetric team has never before been so codependent in maintaining safety for you and your entire community. Arming yourself and teammates with the most current knowledge will help to keep you, your family, and your patients
Triage Tips for the COVID-19 Outbreak
March 9, 2020
[3 MIN READ] In addition to ED volume surges during this flu season, we are now also challenged with concerns related to the coronavirus (COVID-19). Here are some triage tips and considerations to keep in mind. Review your department triage policies and procedures to determine if your organization has made any addenda to them in response to COVID-19. Your role as the triage nurse is not to
Case: How to Disclose Medical Errors to a Patient's Family
February 18, 2020
Do your clinicians have a plan for how to address a patient’s family if a medical error occurs? Consider this true case that was shared with me by a California risk manager – a routine test that goes tragically wrong: "Mrs. Woods is a 53-year old woman who goes to the hospital for a CT-guided biopsy of the liver. The staff assures Mrs. Woods the test is ‘no big deal’ so she tells her husband to go
5 Tips to Reduce Stress as an Obstetric Nurse
February 5, 2020
Is there really such a thing as a normal day on the OB unit? Highly doubtful. Unpredictability and uncertainty loom from the beginning of your shift to the end. But what if you could achieve some control over your day and try to decrease both your personal stress level and the stress of those in your immediate environment? While keeping your day 100% stress-free may not be possible, at
Measuring Clinical Performance Improvement in Obstetrics
January 7, 2020
As heightened U.S. maternal morbidity and mortality rates gain national attention, AWHONN and ACOG, as well as state perinatal quality collaboratives, notably California, have emphasized that hospitals need to focus on improving outcomes with specific attention to the leading causes of maternal mortality. The RSQ® Assessment – Obstetrics provides the framework for the creation of a comprehensive obstetrics safety program within your organization, as well as the foundation for an obstetric culture
Spinal Epidural Abscess: 5 Things You Should Know
December 10, 2019
[3 MIN READ] The incidence of spinal epidural abscess (SEA) has doubled in the past 2 decades due to the epidemic of MRSA infections, the spread of IV drug use, and the increased number of spinal and vascular access procedures. Delayed or missed diagnosis of SEA leads to profound disability or death; lawsuits in this arena are exceptionally costly. Source: Hubspot
Framework for a Physician Integration Program
September 17, 2019
If your organization is navigating the onboarding and integration process for newly employed physicians, you're not alone. The Physicians Advocacy Institute recently reported that U.S. hospitals bought 5,000 independent physician practices between July 2015 and July 2016. The percentage of hospital-employed physicians increased by more than 63% from mid-2012 to mid-2016. TSG's RSQ® Education - Physician Integration Program is designed to put the best practices of patient safety and risk management at the
Informed Consent Process Forms & Documentation
September 10, 2019
[7 MIN READ] Obtaining the informed consent of the patient is required in all states before an invasive procedure that carries a material risk of harm is performed. This is a non-delegable duty of the practitioner who is going to perform the procedure; this means that the practitioner is ultimately responsible for the validity of the consent and cannot avoid liability by claiming that it was someone else’s responsibility. However, obtaining informed consent should not
September 4, 2019
[7 MIN READ] The care of the surgical patient is dependent upon doctors, nurses, technicians and both office and hospital staff. Like all humans, despite their best efforts, they make mistakes. Encouraging them to “try harder” simply will not work. To reduce surgical errors we need to identify root causes and institute system-based processes to prevent them. Studies have suggested specific areas that offer opportunities for improvement. Kim et al.[1] noted that adverse events from
Headache Differential Diagnosis & Documentation
August 27, 2019
[3 MIN READ] Headache is a common reason for a visit to practitioners in primary care, urgent care, and emergency medicine. Patients with the chief complaint of non-traumatic headache comprise 3% of all emergency department visits. The vast majority of these headaches will have a benign etiology such as tension or migraine. Unpredictably interspersed among these benign presentations are patients with a serious cause of headache such as hemorrhage or CNS infection. Malpractice
Framework for a Nursing Clinical Excellence Program
August 19, 2019
[2 MIN READ] Your organization might find itself hiring more new, inexperienced nurses for your emergency department due to the national nursing shortage. While these new hires arrive with a nursing degree, you need to be sure that each has a baseline set of knowledge to effectively treat patients in your ED. Our RSQ® Solutions – Nursing Clinical Excellence Program was designed to help level-set the knowledge base of your clinical workforce.
Behavioral Health Patients in the Emergency Department
August 5, 2019
The number of patients presenting to the emergency department with a psychiatric and/or substance abuse problem has increased in recent years from 6% to 15%. With this significant increase, it’s imperative our EDs have the tools and resources necessary to assess and treat these patients. Mental Illness: Undiagnosed & Untreated While those numbers are helpful in identifying overt problems, it’s interesting to note how many patients coming into EDs have a mental illness that is undiagnosed and
Improving Nursing Retention & Job Satisfaction
July 29, 2019
[2 MIN READ] What does your organization’s Employee Satisfaction Survey really tell you about how staff feel about their roles/jobs? The survey result graphs demonstrate areas that need improvement and more, but do they capture the authenticity and essence of how staff feel when they step onto the unit each shift? Although these surveys are an essential part of evaluating workforce satisfaction – and yes, some are required through a regulatory process –
Chest Pain Differential Diagnosis & Documentation
July 16, 2019
Patients with chest pain are a common and constant challenge to clinicians, whether in the office, clinic, urgent care or emergency department. The clinical presentations may be confusing, the differential diagnoses are myriad, and not all patients with chest pain will have a serious underlying etiology. Lawsuits involving the care of patients with chest pain are frequent and make up the costliest group of malpractice cases
Chest Pain Malpractice Claims & "Bedside Maneuvers"
July 15, 2019
[3 MIN READ] Malpractice claims related to the chief complaint of chest pain continue to plague clinicians. Foremost among these claims is the allegation of “missed MI,” which has now been expanded to include missed unstable angina as well as missed actual myocardial infarction. Although the evaluation of the adult with chest pain is fraught with many pitfalls, one of the most glaring yet avoidable errors is the reliance upon “bedside maneuvers” to exclude the
Nurses: Standardize Patient Education with These Postpartum Warning Signs
July 9, 2019
[9 MIN READ] Standardization is known for reducing variation and increasing consistency; it continues to be a recognized safeguard to decreasing liability and improving outcomes. High-quality postpartum care includes implementation of both standardized discharge processes and teaching that can improve maternal outcomes. AWHONN promotes postpartum discharge standardization and encourages that specific components of postpartum discharge teaching align with leading causes of maternal morbidity and mortality. While we previously outlined best practices in
Framework for an Obstetrics Training Program
July 2, 2019
[2 MIN READ] Designing a continuing education program for your obstetrics department can be a challenging task. You want to balance the needs of all clinicians on your unit, address areas of concern, and keep pace with the ever-changing landscape of evidence-based practice and emerging national guidelines and trends. TSG’s RSQ® Solutions – Obstetrics Education program can meet your needs; our online library offers you the ability to customize your own program
Medication Error Case: Opioid Adverse Drug Event in the Hospital
June 18, 2019
[6 MIN READ] An adverse drug event (ADE) is defined as harm experienced by a patient resulting from exposure to a medication. An ADE can be caused by an error or poor care, but it is estimated that about half of ADEs are caused by a medication error; these are known as preventable adverse drug events. Statistics are staggering; they reveal that ADEs lead to 700,000 ED visits, 100,000 hospitalizations, and between 7,000 and
Framework for an Emergency Medicine Training Program
June 13, 2019
As you start an emergency medicine training program, it can be overwhelming deciding where to start with your coursework. We have found that six to ten courses each year is a nice number. If you know specific areas in which your organization struggles, we certainly recommend starting there. Does your organization struggle with improving patient satisfaction scores? Do your clinicians struggle to communicate and empathize without admitting fault after an adverse event? Have you had any violations or
June 3, 2019
[5 MIN READ] In prior blogs, I reviewed the bare-bones of EMTALA, highlighted recent studies of EMTALA investigations, and summarized recently settled cases of EMTALA violations. In this installment, I outline the requirements of EMTALA as they relate to the role of the on-call physician. EMTALA was passed to prevent the dumping of “non-paying” patients between hospitals. With the enactment of EMTALA, the dumping problem has diminished. The on-call
Apologies and Medical Error: Do Apology Laws Create More Medical Malpractice Lawsuits?
May 28, 2019
[3 MIN READ] In April, a handful of media outlets reported on a Stanford Law Review article that was published in February 2019 claiming that so-called state apology laws may actually increase medical malpractice lawsuits for non-surgeons. The title of the study is “'Sorry' Is Never Enough: How State Apology Laws Fail to Reduce Medical Malpractice Liability Risk." While an initial version of this article was released two years ago, this revision of
Discharge Instructions for Patients: Best Practices
May 20, 2019
[9 MIN READ] Hospital discharge is cited as a vulnerable point in a patient’s care transition. Its effective execution has significant implications on a patient’s recovery trajectory. The most effective tool in a clinician’s toolbox to promote patient healing is the effective delivery of communicating discharge instructions for patients. Source: Hubspot
Measles Outbreak: ACOG Practice Advisory
May 14, 2019
ACOG has issued a practice advisory regarding the recent measles outbreak. Source: Hubspot
Patient Safety in Clinical Trials
May 6, 2019
[12 MIN READ] While the mission of clinical research is to advance the practice of medicine, it is an extremely daunting task to not only manage clinical trials, but to also oversee them to keep patients safe and reduce risk. In a review of numerous malpractice cases related to clinical research, I have found several common denominators and opportunities to improve patient safety. The issues that arise from clinical trials are not typically intentional;
April 15, 2019
The Joint Commission (TJC) defines a Sentinel Event as “a patient safety event (not primarily related to the natural course of the patient’s illness or underlying condition) that reaches a patient and results in any of the following: death, permanent harm, or severe temporary harm and intervention required to sustain life.” TJC adopted a Sentinel Event Policy in 1996 in an effort to assist hospitals in voluntarily reporting, evaluating and reducing risk, and preventing patient harm. The
Best Practices of Postpartum Discharge Teaching
March 18, 2019
[8 MIN READ] Unprecedented maternal mortality and morbidity rates nationwide have pushed healthcare providers and obstetric experts to closely examine all areas of perinatal and obstetric health. Specifically, the postpartum period is a time of heightened patient vulnerability and is fraught with maternal risk. Sixty-one percent of pregnancy-related deaths occur in the postpartum period, making it potentially more hazardous to a woman’s health than the actual pregnancy itself.
EMRs & Physician Burnout: What's the link?
February 26, 2019
With the concept of physician burnout taking center stage, questions have arisen regarding the factors affecting it, either positively or negatively. One particular factor that has been the topic of research is the use of electronic medical records (EMRs), specifically the link, if any, between EMRs and physician burnout. This blog will hopefully answer these questions definitely: EMRs are a causative factor of burnout. These two quotes are fitting in this situation:
Case Examples of EMTALA Violations
February 18, 2019
In Part 1 of the EMTALA blog, I reviewed the bare-bones of what EMTALA is and highlighted recent studies of EMTALA investigations. In this installment, I have summarized nine recently settled EMTALA cases in which monetary penalties were levied by OIG against the hospital that serve to illustrate the factors responsible for alleged violations. Emergency Medicine EMTALA Violations Source: Hubspot
February 12, 2019
[5 MIN READ] EMTALA violations can be a costly lesson for both healthcare providers and organizations. EMTALA is an acronym for the “Emergency Medical Treatment and Labor Act.” This statute was enacted in 1986 for the original purpose of preventing dumping – the practice of refusing service to patients in the emergency department for financial reasons. The final EMTALA statute now extends beyond this initial noble goal and prohibits discrimination against ED patients for any
Understanding Secondary Postpartum Hemorrhage
January 29, 2019
[6 MIN READ] After reading the case with perspective on how to recognize secondary postpartum hemorrhage, it's critical to understand why it occurs and how to treat it. Etiology of Secondary PPH Why does secondary PPH occur? The normal physiologic changes associated with pregnancy are the perfect predisposition for an unrecognized hemorrhage. Typically, pregnant women are young and healthy with increases in circulating blood volume and hormonal and vascular changes specific to
Case: Recognizing Secondary Postpartum Hemorrhage
January 21, 2019
[4 MIN READ] Your Postpartum Patient Your postpartum patient was not complaining. Her vital signs were stable. She had experienced a prolonged labor, but to your knowledge, her vaginal delivery the previous day went well. Her recovery seemed to be progressing nicely. The morning report did not reveal that she was at any risk. Source: Hubspot
Surgery Malpractice: Are Surgeons More Prone to Complaints?
January 15, 2019
[4 MIN READ] Among physicians, surgeons are at increased medicolegal risk compared to non-surgeons; they also have more medical liability claims and claims paid per year. Jena et al.1 found that the probability of facing a claim varied from 15.3% in general surgery to only 5.2% in family general practice. In a recent review of National Practitioner Data Bank (NPDB) records, Schaffer et al.2 noted that the number of paid claims per 1,000 physician years was 30.0
How Medical Technology Can Prevent Opioid Abuse
January 8, 2019
[2 MIN READ] The development of tools and resources to guide the busy practitioner in prescription decision-making is a welcome trend in healthcare, particularly when the information is instantly available from valuable sources, including Prescription Drug Monitoring Programs and the patient’s medication history. As outlined recently by Ms. Caldwell on the MEDHOST blog, marrying these resources into the prescription functionality of an EHR is a key component in the effort to combat
Hot Topics: Top 10 Blogs of 2018
December 28, 2018
We've featured a variety of topics, cases, and missed diagnoses on our blog this year, and we hope that you've found the content useful and relevant. In case you missed some of 2018's most popular posts, here are the top 10 articles from the blog this year, according to our website visitor statistics. Which article is most valuable to you? Source: Hubspot
Triage Training Courses: How to Structure Your Education Program
December 21, 2018
When you serve clinicians with varying experience levels, how do you implement your triage training courses to create an ideal experience for each group? While your implementation plan and structure might vary based on the size of your facility, our experienced triage educators outline these best practices to streamline your program and ensure that expectations are clear. Source: Hubspot
Patient Satisfaction Starts With Physician Satisfaction: Making Sense of the Missed Obvious
December 14, 2018
Over the past few blogs I have written about the interaction of the physician and the patient. I have also discussed that physician satisfaction is the force that drives the practice of medicine. I am hoping that I have made a strong case for the topic today. But what is exactly the “missed obvious?” Source: Hubspot
Code Trauma & Cognitive Errors
December 7, 2018
[3 MIN READ] The risks we face as acute care practitioners are not static—they evolve over time. Just as we master the approach to a longstanding high-risk problem, a new risky patient presentation rears its head to challenge us. Consider ectopic pregnancy. Now that we routinely obtain pregnancy tests on all women from age 10 to 60 and have access to or skills in ultrasound, the evaluation of possible ectopic pregnancy has become largely an
Newborn Identification: A National Patient Safety Initiative
November 30, 2018
[3 MIN READ] Correct patient identification has long been at the top of the list regarding safety. A recent TSG article by Dr. Tom Syzek entitled “Medical Errors, Communication, Teamwork and End of Life: Lessons from Angola” speaks to the importance of correct patient identification and the safety implications surrounding it. This article dovetails nicely with the new 2019 Joint Commission National Patient Safety Goal (NPSG) regarding newborn identification,
Physician Satisfaction: The Alpha & Omega of Medicine!
November 23, 2018
“I just wish they would let us be doctors.” These words came from the mouth of my colleague while we were working together in the emergency department one night. He was sharing his frustrations with his scribe at the time, lamenting the nostalgic and romantic idea of having the freedom to practice as a physician! His phrase resonates with so many physicians, and in its sentiment lies the very essence of physician burnout, loss of engagement,
Strategies to Reduce Harm from Opioid Prescribing & Abuse
November 14, 2018
9 MIN READ I certainly don’t pretend to have the answer to the question of how to eliminate the opioid epidemic. There are legislative, regulatory and policy issues far greater than any one of us, but what can the medical community do? This was the call to action by Stephen Stack, President of the AMA, who also happens to be an emergency physician. Dr. Stack clearly labels this as an epidemic and
Opioid Prescribing & Liability Trends
November 9, 2018
[5 MIN READ] In a recent blog entitled “The Opioid Crisis: Far From Over,” I reviewed the genesis, magnitude and impact of the opioid crisis in America. Now I will switch gears a bit and look at the trends in the liability of opioid prescribing. Civil Liabilities First there’s civil liability, which can and does result in fines and judgment awards. One potential civil liability is overprescribing opioids in
The Opioid Crisis: Far from Over
October 31, 2018
[12 MIN READ] For the past two decades, the U.S. has experienced alarming rates of opioid use, misuse, abuse, and overdose deaths, and we are now ground zero for the opioid epidemic. This epidemic is rife with risks for patients, practitioners, insurers, healthcare organizations, communities, and our entire society. This is the first article in a three-part series in which we’ll explore the opioid epidemic, liability trends related to opioid prescribing, and strategies to reduce
Medical Errors, Communication, Teamwork, and the End-of-Life: Lessons from Angola
October 24, 2018
(adapted with permission from the original by Dr. Tim Kubacki at https://kubackisinangola.com/) Dr. Tom Syzek: These days we hear so much about the importance of communication and teamwork in avoiding medical errors and how we deliver care at the end of life, I thought for perspective, I would share this case presentation from Dr. Tim Kubacki. Tim is a friend and colleague who left behind the comfortable life of an emergency physician in
How to Engage Nurses in Your Training Program
October 17, 2018
Education is a vital to your department’s ongoing clinical performance improvement plans. But the presence of a plan alone isn’t the change catalyst. Through our twenty years of working with large health systems across the country, we have seen that facilities that successfully engage their staff in a new training program have a much higher likelihood of implementing change and positively impacting patient outcomes. Here are 8 strategies to engage learners in your training program so your
The Physician-Patient Interaction: The Key Elements of Mastering the Moment
September 26, 2018
Behavioral neuroscientists talk about the moment, the exact second we make a decision and act upon it. They describe in almost obsessive detail all the neuronal pathways and neuronal firings that occur in our brain. They talk about influences of past and present, knowledge acquired and remembered, skills honed and sculpted, abilities, beliefs, social backgrounds, immediate stressors, mood, medications, current/immediate/past circumstances, possible future implications, and so much more. If you stop to think about it, what goes
Retained Surgical Sponge: Never Means NEVER!
September 5, 2018
The Problem The term “Never Events” was used in 2001 to describe a subset of medical errors that, ideally, should never occur. Also known as “Serious Reportable Events,” they encompass a wide variety of surgical, device, patient protection, care management, environmental, radiologic and criminal events. The Agency for Healthcare Research and Quality currently defines 29 such events,[i] one of which is defined as “Unintended retention of a foreign object in
Pay for Performance: Destroying the Essence of Medicine!
August 28, 2018
According to Sir William Osler, “Medicine arose out of the primal sympathy of man with man; out of the desire to help those in sorrow, need and sickness.” I will highlight two words: “primal sympathy.” Empathy and sympathy have been researched extensively in the human brain. To summarize, being altruistic, having sympathy, and being empathetic are primal instincts in us; these instincts are no different than hunger or thirst. Source:
Top 10 Risks in Ambulatory Practice
August 21, 2018
In 2014, there were 885 million physician office visits. Over half of these visits occurred in primary care –family medicine, internal, medicine, pediatrics and others – but there are still hundreds of millions of visits to medical and surgical specialists as well. Based on information available from journal publications and claims data, we assembled this list of the top ten risk and safety issues pertinent to ambulatory care settings. While this list is not exhaustive, it represents
Optimizing Post-Delivery Care with Breastfeeding
August 13, 2018
World Breastfeeding Month gives us an opportunity to highlight the benefits of breastfeeding as a life-saving infant feeding practice. In support of the importance of breastfeeding exclusivity and skin-to-skin (STS) for the reduction of infant morbidity and mortality, Bill Gates recently wrote, “Some of the best breakthrough ideas don’t involve technology at all. There is a solution that is readily available, requires no special equipment, and is so cheap any government can support it.”
August 7, 2018
How do you determine who is actually competent to triage? If you do have a competency assessment plan, is it documented in writing? How do you know it is effective? Is it up to date? These and many other questions arise when exploring the development and documentation of a triage competency validation process. Answers to these questions are imperative, as they not only impact litigation that may arise, but are also essential for ensuring
Avoiding the Dead Leg: Acute Limb Ischemia (ALI)
July 23, 2018
Medical errors related to vascular emergencies are common and costly. From head to toe, the vascular system is a fertile field for risk and error waiting to entangle the unwary practitioner. Starting at the top, the high-risk vascular entities include a trio of hemorrhages (subarachnoid, subdural, and epidural) and the ischemic duo of TIA and stroke. In the chest reside some of the big hitters – acute coronary syndrome, pulmonary embolism,
July 18, 2018
Every day in the practice of medicine, hundreds of thousands of urine samples are tested. The maxim that states “all females between ages 10 and 60 with abdominal pain must have a urine pregnancy test” has been ingrained into our cerebral cortexes. Since the times of ancient medicine, the urinalysis has been used to screen for a host of diseases. The urinalysis is a vital tool in evaluating patients. However, as helpful as it is, it has
10 Medical-Legal Basics Every Provider Must Know
July 2, 2018
Regulations, rules, litigation, and medical errors are not the most popular topics for the busy clinician. Most of us would rather gargle nuclear waste than spend a precious evening reading about these issues that plague the pure and honorable practice of medicine. However, we avoid such matters at the peril of our patients’ safety as well as our own personal and professional well-being. Since few (if any) of us will invest in a treatise the length of
Case: Boarding Psychiatric Patients in the ED
June 15, 2018
Recent studies demonstrate that about 10% of all emergency department patients present with psychiatric illness. Because of the unique risks associated with psychiatric patients, coordinating their care and admission has proven to be a challenge for emergency physicians. Here we present a case that highlights the risks of boarding patients in the emergency department. Source: Hubspot
Triage Goals: Rapidly Identifying & Sorting Patients
June 5, 2018
A 25-year-old male presents to an emergency department at his local community hospital with abdominal pain. The department is at its peak time of patient flow, and every bed is filled. The patient is called to the triage area; the nurse assesses him and assigns a triage level decision to his chart. His triage nurse must consider the following: Is his abdominal pain a potential for demise? How long will he wait to be seen by
Cognitive Errors in the Failure to Diagnose: Anchoring
May 24, 2018
Why was the diagnosis really missed? In my previous position as Manager of Risk, Claims & Insurance for our physician group, the available methods of error analysis never satisfied my quest for the ultimate answer to this recurrent question in any given case. The majority of our group practice was emergency medicine; our claims data mirrored the national trends showing that most claims were “diagnosis-related,” which contained the allegation that a clinician was negligent by either not
How to Obtain Clinician Support
May 17, 2018
Once you have allocated resources toward your performance improvement initiative, the next best practice in initiative implementation involves getting your clinicians to support it. Engaging clinicians early in any initiative is crucial to success. If they decide against participating in the program, morale can suffer. Conversely, clinicians who embrace the program have testified to its worth in improving their practice, saving patient lives and enhancing morale.
Measuring Clinical Performance Improvement in Emergency Medicine
May 8, 2018
The RSQ® Solutions – Emergency Medicine Assessment is a retrospective chart review tool providing a granular analysis on physician practice patterns. The online tool focuses on the 10 highest risk chief complaints in emergency medicine and measures clinical alignment around best practice and documentation compliance with these high-risk patients. Source: Hubspot
Preventing Medical Errors: 7 Things Every Provider Needs to Know
May 4, 2018
Despite the wake-up call given 18 years ago by the Institute of Medicine’s report “To Err is Human,” medical errors still occur at alarming rates. The landmark publication estimated that up to 98,000 Americans die each year from medical errors, and one out of every twenty-five hospitalized patients is harmed by a medical mistake. There is, however, cause for guarded optimism. Many organizations, agencies and legislatures have stepped forward and created solutions and educational programs targeted at
Identifying Resources & Personnel for Initiative Implementation
April 25, 2018
On the journey to improve the quality of patient care, initiatives to enhance clinical performance are necessary. Nevertheless, they can seem to be a daunting task; in fact, these initiatives require several well-orchestrated steps to ensure the program reaches its full impact potential. Over the past decade, The Sullivan Group has partnered with some of the largest health systems in the country to successfully implement clinical performance improvement programs proven to change clinical practice.
Physician Burnout: An Emotionally Malignant Disease
April 16, 2018
Physician burnout is as epidemic as the plague once was, as malignant as the most devastating cancer, and as silent an assassin as hypertension. The topic has garnered much attention not only because of its impact on the healthcare practitioner, but also due to its detriment to the patient. While a search for the term “physician burnout” produces massive amounts of data, self-help tips, and advice on prevention, the conversation lacks organization, uniformity and a standardized approach
What is the Triage Competency Assessment Tool?
April 9, 2018
According to ENA, retrospective chart review is a critical element of ongoing triage competency validation. The RSQ® Solutions – Triage Assessment tool is built upon triage best practices and provides a mechanism through which your organization can implement and execute a scalable and sustainable chart review process. Source: Hubspot
EMTALA and Psychiatric Hospitals
March 26, 2018
There seems to be a widespread misperception among freestanding psychiatric facilities that the Emergency Medical Treatment and Labor Act, 42 U.S.C. § 1395dd (EMTALA), does not apply to them. This may or may not be true depending upon the licensure and the configuration of the facility. It is not as simple as a yes/no calculation. There are three criteria that must be met before a facility can be held liable for a violation of EMTALA:
Informed Consent Form Process & Documentation
March 19, 2018
Obtaining the informed consent of the patient is required in all states before an invasive procedure that carries a material risk of harm is performed. This is a non-delegable duty of the practitioner who is going to perform the procedure; this means that the practitioner is ultimately responsible for the validity of the consent and cannot avoid liability by claiming that it was someone else’s responsibility. Source: Hubspot
5 Reasons to Use Retrospective Chart Review for Triage Competency Validation
March 12, 2018
Because every patient entering the emergency department needs to be triaged, it is imperative to ensure that every triage nurse maintains accurate clinical decision-making skills that support optimization of patient flow. While the Emergency Nurses Association (ENA) has historically recommended ongoing competency validation to ensure safe practice in the ED, the organization updated itsTriage Qualifications and Competency Position Statementin 2017 to place greater emphasis on the use of
6 Common Errors in Fetal Heart Monitoring (FHM)
March 5, 2018
Have you ever wondered as an Labor and Delivery RN how many hours during your shift you spend staring at fetal heart tracings? I’ll bet you have never tried to tally such a figure, but I’d venture to guess it encompasses not only a large portion of your daily practice, but an enormous part of your career as well. During a 12-hour shift of managing labor induction, you could easily spend approximately 5-6 hours or more actually
CASE: Refusal of Care Based Upon Religious Beliefs
February 26, 2018
In today’s case presentation, we will navigate the difficult waters of patient refusal of life-saving care based upon religious beliefs. In this actual case, a woman’s life hung the balance. There was little time for formal mental status evaluation or communication with legal counsel or a local judge. It was around 8:30 pm during a busy shift in the Cook County Emergency Department. A young woman had been rolled into the department with low blood pressure.
CASE: Suicide in the Emergency Department
February 19, 2018
Providing care to psychiatric patients in the emergency department is a challenge for many reasons. Emergency physicians often receive insufficient training in behavioral emergencies. ED personnel are uncomfortable evaluating and treating these patients. ED staff may harbor negative attitudes toward behavioral health patients. Resources such as consultants and inpatient beds are lacking. The hectic ED environment can lead to iatrogenic escalation
February 12, 2018
Clinicians issue tens of millions of warfarin prescriptions each year in the U.S., despite the increasing use of alternative anticoagulant medications. Practitioners will continue to encounter warfarin, known both for its irreplaceable value and potential for life-threatening complications. Due to the propensity for permanent disability and death from hemorrhagic complications, litigation is common and costly. Knowledge of the pharmacology, indications, monitoring, drug interactions and complications of warfarin is an essential tool to avoid patient harm,
Consequences & Patient Safety Implications of Disruptive Behavior in Healthcare
February 5, 2018
Surgery Is a Team Sport As a Vascular Surgeon, I have had the honor and privilege of serving not only as an Attending Surgeon, but as a Division Chief, Professor of Surgery, Surgical Residency Director and Chairman of Surgery. One’s perspective on incivility in the operating room (OR) depends on one’s position and responsibility. I was trained during a period of time when bombastic behavior by the senior surgeon was accepted, sometimes expected, and always legendary. Shall
Incivility & Disruptive Behavior in the Healthcare Setting: Part 1
January 29, 2018
Many would contend that we currently live in a polarized society in the United States. Whether the issue is the environment, healthcare, taxes, religion, economic theory, immigration, globalization or politics, interaction between competing philosophies is often characterized by animosity, accusations, verbal abuse, and even physical harm. Make no mistake — this has been going on since the Garden of Eden (Ask Cain; better yet, ask Abel!). The impact on society is rarely, if ever, beneficial.
Pediatric Abdominal Emergencies
January 22, 2018
Infants and children with acute abdominal pain present to emergency departments, urgent care centers and physician offices with a variety of signs and symptoms. Since infants can’t localize pain and pre-school children are often imprecise in their responses, the healthcare practitioner may find it difficult to ascertain the actual dilemma. Source: Hubspot
January 15, 2018
Intoxication! Talk about a red flag! Let’s consider two “flavors,” if you will. First, the patient with an actual chief complaint AND who happens to be intoxicated. Next, the patient who presents with apparent intoxication and no other immediately obvious issues. And for those of you who have not had a busy shift in an urban emergency department, the number of patients with altered mentation secondary to alcohol can be remarkable. Unfortunately, many of these patients get
EMTALA Considerations for Triage
January 8, 2018
When most people think of triage, they think of nurses making sense of the chaos caused by 141 million annual visits to the ED. Patients who are part of this massive onslaught of unscheduled care arrive daily at any hour, and the first person they see is someone in triage, usually a nurse, whose job is to quickly figure out who needs to be seen in what order. In my early practice years, my
Defending Shoulder Dystocia Claims
October 16, 2017
There is only one thing that frightens an obstetrician more than a difficult shoulder dystocia delivery − getting a letter from a plaintiff attorney notifying you that you are being sued for alleged malpractice in a shoulder dystocia delivery you did several years ago. What is especially upsetting is that you remember that delivery, how quickly everything happened, and how well you performed in the heat of the moment to save that baby's life. You did your best,
Code STEMI: Calling Dr. Herrick
October 5, 2017
We hear the overhead announcements all the time in the hospital … Code Blue … Code Red … and more recently, Code Trauma … Code STEMI … Code Stroke … and Code Sepsis. From the standpoint of risk and safety, these latter four are the “Codes” that practitioners and nurses must master in order to deliver the best possible care in the safest manner, thereby reducing risk
Preventing Surgical Site Infections
September 25, 2017
Surgical Site infections (SSIs) occur in 2% to 5% of surgery patients. This category of infection comprises approximately 22% of all healthcare-associated infections and has a 3% mortality. Patients with SSIs require significant care and average 7 to 10 days of increased length of hospital stay. The cost of providing care for a single SSI ranges from $3,000 to $29,000. The total cost of care for SSIs is estimated at $10
Preventing CAUTI (Catheter-Associated UTI)
September 18, 2017
Catheter-associated urinary tract infections are the fourth most common HAI. They comprise over 12% of all acquired infections in acute care hospitals. 93,300 of these UTIs are estimated to be acquired in hospitals each year, with an estimated death toll of 13,000 patients. Source: Hubspot
Case: Avoiding Cognitive Bias in Diagnosing Sepsis
September 11, 2017
If you ask leadership at many hospital organizations to name their highest current quality priority, many will respond that it is sepsis. In recent years, medical researchers have identified that key interventions dramatically alter the course of sepsis. Key factors such as early identification, early administration of antibiotics, and appropriate fluid loading significantly reduce morbidity and mortality. Hospitals and organizations that have followed the evidence have consistently demonstrated significant improvements in patient outcomes.
September 7, 2017
Over the last several months, many of our articles have focused on the importance of redesigning physician documentation systems to increase patient safety and minimize diagnosis-related errors. If you are familiar with The Sullivan Group, you clearly understand the alignment of that topic with our mission and the role we have played with many health systems and EMR vendors to further that mission. However, we also recognize the importance of efficiency, speed, and productivity
Preventing Central Line-Associated Blood Stream Infections (CLABSI)
September 5, 2017
The CDC defines a Central Line-Associated Bloodstream Infection as: “A laboratory-confirmed bloodstream infection (LCBI) where central line (CL) or umbilical catheter (UC) was in place for more than 2 calendar days on the date of event, with day of device placement being Day 1 and the line was in place on the date of event or the day before.” In other words, the patient must have had the device in place for at least 2 days and
Healthcare-Associated Infections
August 28, 2017
The Centers for Disease Control and Prevention defines healthcare-associated infections (HAIs) as: “Infections that patients acquire during the course of receiving healthcare treatment for other conditions.” Healthcare-associated infections are very common, and the cost associated with them is enormous. It is estimated that 1 out of every 25 hospitalized patients is treated for an HAI, with costs ranging between $28 billion and $33 billion per year. Source:
Striking the Balance with EMR Risk Notifications
August 23, 2017
In general, practitioners don’t appreciate anything that “pops up” or gets in the way of their typical workflow. This aspect of some EMRs can cause dissatisfaction, even anger. A good example is warnings related to medication prescribing. In some programs, drug interactions of any severity and their complications litter the screen with overwhelming frequency. This simply becomes white noise and is soon ignored, sometimes to the peril of the patient as
Triage Questions for Chest Pain & Chest-Related Symptoms
August 21, 2017
When a patient presents with chest pain or chest-related symptoms, the role of the triage nurse is to critically evaluate the relationship of risk factors to outcome potentials to make the best triage decisions. The more risk factors a patient has, the greater the triage nurse’s concern for a potential high-risk scenario. In this blog, we will propose several triage questions for chest pain and consider several serious concerns that can prompt a patient to present with
Vital Signs: Leveraging the EMR to Heighten Awareness
August 16, 2017
In emergency medicine and presumably in urgent and primary care, one of the common failure-to-diagnose drivers is the failure to recognize or act upon abnormal vital signs. In one analysis of 90,000 patients that we published in Annals of Emergency Medicine, 16% of patients presented to the emergency department with an abnormal vital sign, and 10% of that group went home without a single repeat of the abnormal vital sign. That analysis came from
August 14, 2017
Acute ischemic stroke affects about 800,000 patients a year in the U.S.; 600,000 of these cases are a first stroke. Stroke is a leading cause of permanent cognitive and function-limiting disability, and it ranks fifth among all causes of death. Prompt recognition of an acute ischemic stroke is crucial, as studies show that the volume of irreversibly damaged brain tissue expands rapidly until reperfusion occurs. The American Heart Association guidelines call for rapidly
Encouraging the Maternal-Fetal Triage Index OB Triage Tool
August 7, 2017
The Maternal Fetal Triage Index (MFTI) tool developed by obstetric experts at AWHONN is a recent advance that deserves attention from all obstetric professionals. If you haven’t yet learned of it, stay tuned, because you will be hearing much about it as it goes “live” in the EMR of many institutions around the country. Source: Hubspot
Embedding Evidence-Based Medicine into EMR Physician Documentation
August 3, 2017
Practitioners should employ Evidence-Based Medicine or Best Evidence whenever possible. No one would argue with that. If a patient presenting with chest pain has a very low probability of a pulmonary embolism based on good evidence, it would be inappropriate to order a CT scan and expose a patient to the dangers of unnecessary radiation. Alternatively, if an algorithm suggests that pulmonary embolism is likely or probable, it would be inappropriate to “fail to
4 Clinical Tips for Triage Nurses
July 31, 2017
Accurate triage of patients in an emergency department is critical to timely care and patient safety. Source: Hubspot
Clinical Decision Support in the “Mental Workflow”
July 28, 2017
In order to provide the highest quality and safest care, medical practitioners should have immediate access to clinical decision support. Medicine should not be a memory game; in fact, according to an analysis by Allan Kachalia, MD, JD, published in the Annals of Emergency Medicine, relying solely on memory could leave you more susceptible to cognitive errors that lead to malpractice claims. Kachalia’s closed claims analysis found that cognitive errors were
Shoulder Dystocia Risk Factors
July 24, 2017
You have been following this 22-year-old primigravida patient since she transferred into your practice at 18 weeks gestation. She tells you that she started her pregnancy weighing 195 pounds; it is now two weeks before her due date and she weighs 248 pounds. She failed her 28-week glucose screen; after the 3-hour oral glucose tolerance test, she was diagnosed as being a gestational diabetic. Despite referrals to a dietitian and to the Diabetes Clinic, her blood sugar control and dietary
Optimizing e-Learning for Healthcare Professionals
July 17, 2017
Every healthcare professional is familiar with the traditional learning methods of classroom lectures, texts, conferences and hands-on clinical training. For “experienced” older clinicians (like me) educated during the pre-internet era, these were the exclusive methods employed during college, medical/nursing school, internship, residency and beyond. You went to lectures, hit the books, and relied on the “watch one, do one, teach one” process of mastering new procedures. Source: Hubspot
Does Guided EMR Documentation Impact Clinical Practice, Documentation Compliance and Outcomes?
July 14, 2017
In a previous article entitled “Should Your EHR Documentation Templates Include Chief Complaint Specific Content,” we emphasized the importance of providing chief compliant-specific content in physician documentation templates for medical specialties that are susceptible to diagnosis-related errors. Let’s advance that concept a step further and explore what other features could be built into an EMR to increase compliance with the key drivers of clinical decision-making in the history and physical exam. For example, would it make
End-User vs. Risk Management: Expectations of the EMR
July 10, 2017
Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems were developed to satisfy several important needs (I will use EMR and EHR interchangeably). Just to name a few: legible documentation of patient encounters, satisfaction of coding and billing requirements, regulatory compliance, prevention of medication errors, clinical pathway utilization, medical-legal defensibility, and data compilation. Having seen and used several EMR systems, I can tell you that they were not developed with the primary goal of
Should Your EHR Documentation Templates Include Chief Complaint-Specific Content?
July 7, 2017
As a follow-up to last week’s article The History of EMRs: Opportunities to Improve Patient Safety, we explore the philosophy around providing EHR documentation templates that include specialty-specific, chief complaint clinical content. Doing so provokes a few big-picture questions about healthcare information technology and the appropriate strategy for designing clinical applications that providers work with daily. Source: Hubspot
SLIDESHARE: The ABCs of Healthcare Risk Management
July 7, 2017
One of our goals at The Sullivan Group is to bring you practical pearls to reduce risk, improve patient safety, and enhance quality in your everyday practice. To that end I thought I would share with you this “alphabet soup” of healthcare risk management and patient safety tips assembled from years of observation and experience. Source: Hubspot
The History of EMRs & Opportunities to Improve Patient Safety
June 29, 2017
Over the next eight weeks, we will be providing information on EHRs/EMRs that have proven to improve patient safety, reduce medical errors and reduce litigation. In this first week, we provide historical context on the events leading up to today’s current state of electronic provider documentation. This series aims to help shed light on the improvements available for EMR physician documentation and to provide key takeaways to implement
June 26, 2017
With preeclampsia affecting 10% of all pregnancies and rates rising by 25% in the past two decades, it is important to test your knowledge and ensure that all your patients have a strong understanding of the dangers of preeclampsia. This is part II of a two-part series. Part I focused on definitions, risks, prevention and diagnosis of preeclampsia; part II focuses on HELLP syndrome, treatment, eclampsia, future risk and resources.
Do Clinical Competency, Patient Safety and Nurse Turnover Rates Correlate?
June 23, 2017
Our mission at The Sullivan Group is to positively change clinical practice, improve patient safety and reduce malpractice litigation. Because of this, we are often asked by clinical leaders and clients to explore the impact our RSQ® Solutions platform may have on other areas of the healthcare business. A Chief Nursing Officer with whom we have worked for the past several years connected with me at the 19th Annual NPSF Patient Safety Congress in Orlando, FL,
June 19, 2017
Any discussion of communication in healthcare must include the process of transferring patients and their vital medical information from one provider to another and/or from one healthcare setting to another. Such transfers are known as healthcare handoffs; examples include when a patient is transferred from an ambulance to an ED or when a surgical patient is moved from the recovery room to a surgical floor. Source: Hubspot
Case: Is Lumbar Puncture Necessary to Rule Out Subarachnoid Hemorrhage?
June 12, 2017
The case presentation will be a little different than our typical failure to diagnose an aortic disaster or other common “failure to diagnose” entity in emergency medicine. Although those are great teaching cases, there is another critically important side to the patient safety coin. It is critical to do the appropriate testing to identify potentially fatal presentations, but it is equally important to understand when such testing is
MEDITECH Physician Documentation in the ED: Chief Complaint-Specific vs. General Templates
June 7, 2017
As electronic medical records have evolved, so have physician documentation methods. Based on our observations in recent years, we have noticed that as organizations migrated away from paper templates, many only developed two or three generic electronic documentation templates for physicians to use (Adult Template, Pediatric Template, Trauma Template). Source: Hubspot
Vulnerable Adult & Elder Abuse
June 5, 2017
There are a number of laws in the various states that prohibit the abuse or exploitation of certain classes of people. The classes of persons who are protected generally include those who are particularly vulnerable to abuse and who may be incapable of defending themselves. The prohibition against child abuse is inherent in virtually all state statutory schemes and is widely known. Less well known, at least outside the long-term care industry, is the prohibition against
Defining and Diagnosing Preeclampsia
June 1, 2017
With preeclampsia affecting 10% of all pregnancies and rates rising by 25% in the past two decades, it is important to test your knowledge and ensure that all your patients have a strong understanding of the dangers of preeclampsia. This blog will be divided into a two-part series Part I focuses on definitions, risks, prevention and diagnosis of preeclampsia; part II focuses on HELLP syndrome, treatment, eclampsia, future risk and resources.
Code Sepsis: Recognize, Resuscitate, and Refer
May 30, 2017
There are four time-sensitive emergencies that that every practitioner of acute care medicine should master to deliver the best possible care in the safest manner: Code Trauma, Code STEMI, Code Stroke, and today's topic – Code Sepsis. Depending on the specialty, practitioners are involved in sepsis care at one or more stages of sepsis. In the office, urgent care or ED, the first two stages are paramount – early recognition and aggressive resuscitation. Hospitalists and
Physician Documentation Templates in MEDITECH – Workflow Videos
May 24, 2017
Although most of The Sullivan Group’s RSQ® Solutions platform is delivered online via CME/CE courses and clinical performance assessments, there is another major component to the RSQ® Cycle, which involves building clinical risk mitigation strategies directly into the EMR. In 2010, one of our largest clients requested that we develop a library of physician documentation templates for their enterprise EHR system, which happened to be MEDITECH. After several years of development
Strategies to Improve Provider-Patient Communication
May 22, 2017
Physicians, nurses and other “healers” have had special relationships with patients for centuries. This unique bond between those who provide medical treatment and those who receive their care is currently being endangered by a massive and impersonal healthcare delivery system that is becoming more dependent on automation and technology with each passing year. The good news is that patient attitudes, impressions, and subsequent compliance with treatment plans can be positively influenced when healthcare professionals improve
10 Reasons Your Urgent Care Isn't as Safe as You Think It Is
May 17, 2017
Based on our experience, research, and an analysis ofthousands of malpractice cases in acute care, includingemergency departments and urgent care centers, wehave uncovered several critical risk and safety issuesof which you may not be aware. Source: Hubspot
Differential Diagnosis for Abdominal Pain & Documentation Pearls
May 15, 2017
Patients with abdominal pain are a common and constant challenge to practitioners in primary care, pediatrics, urgent care, and emergency medicine. The complaint of “stomach and abdominal pain” comprised 7.7% of ED visits in 2013. The clinical presentations may be confusing, the differential diagnoses for abdominal pain are myriad, and not all patients with abdominal pain will have a serious underlying etiology. Source: Hubspot
7 Clinical Topics to Consider for Your Patient Safety Initiatives
May 11, 2017
Over the last 19 years, clients have watched TSG’s library of online courses grow from 10 courses focused on Emergency Medicine to over 275 courses that span the spectrum of healthcare. We are often asked by clients, “Which courses should we focus on first?” While this answer varies greatly based on the specifics of each client, we have taken the liberty of creating a list of courses/topics that
Differential Diagnosis for Headache & Documentation Pearls
May 8, 2017
Headache is a common reason for a visit to practitioners in primary care, urgent care, and emergency medicine. Patients with the chief complaint of non-traumatic headache comprise 3% of all emergency department visits. The vast majority of these headaches will have a benign etiology such as tension or migraine. Unpredictably interspersed among these benign presentations are patients with a serious cause of headache such as hemorrhage or CNS infection.
4 Key Areas for Physician Integration & Onboarding
May 3, 2017
Over the last seven years, there has been a significant increase in the number of physicians that are employed by hospitals and health systems. Many of those employment changes were driven by aspects of the PPACA that favored a more “integrated” approach to clinical care. Although the aggressive employment strategy has subsided, there remains a significant interest by hospital systems to more closely align with physician group practices. To this point, let’s explore 4 key areas that
Code Stroke: A Syndrome of Subtraction
May 1, 2017
There are four time-sensitive and life-threatening clinical presentations that every acute care practitioner must master to deliver the best possible care in the safest manner. The first two have been around a while and should be very familiar – Code Trauma and Code STEMI. The next two are less dramatic than trauma and heart attacks, but are no less critical – Code Stroke and Code Sepsis. Here are some highlights of Code Stroke.
MEDITECH Physician Documentation Templates: Implementation Details
April 26, 2017
With HITECH in full swing and hospitals and health systems across the nation implementing electronic medical record systems, some for the first time, many are finding that the MEDITECH solution, while fantastic for billing, coding and reporting, perhaps leaves a little to be desired where the end-users in the ED are concerned. Many ED providers accustomed to structured paper chart templates found themselves essentially unsupported on the EMR front. Answering the call for , we developed RSQ®
April 24, 2017
Most physicians are aware that there is a duty to provide reasonable care in the patient-physician relationship. Typically, malpractice liability does not extend to anyone outside of that relationship. However, there are certain extraordinary circumstances in which a physician may have an obligation to a third party, one that is outside the patient-physician relationship. Source: Hubspot
[Infographic] The State of Healthcare Cyber Liability
April 21, 2017
The threat of a cyber attack seems only to be increasing in healthcare. Recent reports show security issues include losses by large and small providers. Based on the reports in the media, it would appear that no one is immune to this threat. Before we look for ways to minimize cyber risk, it's important to understand the state of healthcare cyber liability. Source: Hubspot
Overcrowding in the Emergency Department
April 17, 2017
Too many patients in too little space subjected to inefficient processes. This is the essence of overcrowding in the Emergency Department. In the 40 years since 1975, the number of hospitals has declined from over 7,000 to about 5,700. Hospital bed capacity fell during the same period from 1.5 million to fewer than a million. Meanwhile, the number of ED visits has increased almost every year, totaling 136 million by 2011. The resulting formula for overcrowding
Mapping Clinical Risks to Frequent Obstetrics Claims
April 12, 2017
Since we recently laid out an exercise mapping clinical risks to frequent diagnosis-related claims in Emergency Medicine, we're circling back to recommend a risk mitigation exercise for another area of high risk medicine, Obstetrics. A recent The Doctors Company analysis identified the most frequent obstetric claims as: 22% Delay in Treatment of Fetal Distress 20% Improper Performance of Vaginal Delivery 17% Improper Management of Pregnancy
Making the Biggest Impact on Patient Safety: Where to Focus?
April 10, 2017
Anything and everything that improves patient safety is important. The sheer weight of that sentence can be overwhelming to healthcare professionals. Consider one conclusion from the Institute of Medicine (IOC) report “Improving Diagnosis in Healthcare” that states, “Advancing patient safety requires an overarching shift from reactive, piecemeal interventions to a total systems approach to safety in which safety is systematic and is uniformly applied across the total process.”
April 3, 2017
April is National Child Abuse Prevention Month, and I thought it would be worthwhile to review the scope of the problem we are trying to prevent. Child physical abuse exists in all corners of the country and affects children of all ages, ethnicities and socioeconomic groups. Consider the following facts: More than 2 million reports of suspected child maltreatment are investigated each year in the United States.
Mapping Clinical Risks to Frequent Diagnosis-Related Claims
March 31, 2017
Many organizations that study medical liability trends often point to breakdowns in communication, cognitive errors, lapse in clinical judgement, etc. as the main contributing factors that cause diagnosis-related claims. Because 60% of Emergency Medicine claims are diagnosis-related, every health care organization should have a strategy for mapping and organizing the most common clinical risk areas that physician’s face. Below we outline a tool that aims to help health systems organize a strategy to
10 Principles of Geriatric Care in Acute Settings
March 27, 2017
Whether we like it or not, the future of medicine is geriatrics. As the demographics in the United States change in the next 50 years, it is predicted that practitioners will find themselves providing care to a much larger group of elderly patients. For example, the 2014 census data showed that 14.5% of the U.S. population was 65 years of age or older. By 2040, it is estimated that this age group will grow to comprise 22%
[INFOGRAPHIC] Understanding Diagnostic Error
March 22, 2017
Diagnostic error poses a significant threat to patient safety. According to a 2007-2013 closed claims analysis from The Doctors Company, missed or delayed diagnoses are responsible for 57% of malpractice claims in emergency medicine. Before we can design patient safety initiatives to address diagnostic error in our organizations, we must first understand the breadth of the issue. This infographic outlines the scope of diagnostic error and breakdowns in the diagnostic process that can lead
Case: Vertebral Artery Dissection
March 20, 2017
In this case, we present an incredible day-by-day progression from the moment of onset of a vertebral artery dissection as told by the emergency physicianwho had it! Vertebrobasilar artery thrombosis or dissection affecting the posterior circulation can be extraordinarily difficult to diagnose. In the failure to diagnose specialties such asprimary care, internal medicine, family practice, emergency medicine and urgent care where the door is open to all, risk and safety education and evaluation focused around this deadly high-risk clinical entity is critical.
5 Recommendations to Reduce Obstetric Nursing Stress
March 15, 2017
Is there really such a thing as a normal day on the OB unit? Highly doubtful. Unpredictability and uncertainty loom from the beginning of your shift to the end. But what if you could achieve some control over your day and try to decrease both your personal stress level and the stress of those in your immediate environment? While keeping your day 100% stress-free may not be possible, at least lowering
Your Hospital Safety Culture: Strengths and Weaknesses
March 13, 2017
According to the most recent survey on hospital culture by the Agency for Healthcare Research and Quality (AHRQ), provider perception of a positive hospital safety culture was the lowest for questions concerning the presence of non-punitive response to errors, effective handoffs and transitions, and adequate staffing. These results are detailed by the AHRQ in the “Hospital Survey on Patient Safety Culture 2016 User Comparative Database Report.” Source: Hubspot
Q&A: Implementing a Communication and Resolution Program
March 8, 2017
Tom Syzek, MD, FACEP, served as the Chief Risk Officer of a multi-specialty physician group and President of the group’s captive insurance company. In those roles, he was the focal point for the Communication and Resolution Program (CRP); he attributes many prevented lawsuits to an effective communication and resolution strategy. We picked Tom’s brain to understand some key questions that we hear clients ask about Communication & Resolution Programs.
Triage: The Acutely Agitated Patient
March 6, 2017
Patients with mental health complaints are visiting emergency departments and urgent care centers at an increasing rate. It is imperative that triage staff are able to make rapid and safe decisions for these patients. Rule #1: Make No Assumptions Making assumptions in triage is dangerous. Our subconscious biases can lead to cognitive errors in the assessment of patients, particularly those who are agitated. Source: Hubspot
How 5 Physician Documentation Methods Compare to Facilitate Safer Care
March 2, 2017
Physician workflow frustrations are cited by several studies as a significant contributing factor to physician burnout, an epidemic estimated to impact 51% of the physician population according to Medscape’s 2017 study. Because burnout can be tied to risks in patient safety, improvements in physician workflow are key components in the patient safety movement. Source: Hubspot
February 27, 2017
Pain management in the acute care setting (ED, Urgent Care, office) has once again catapulted to the top of the list of hot topics. Years ago the conversation centered on recognizing pain as a “fifth vital sign” and navigating the tricky crossroad of patient satisfaction and the provision of timely, sufficient pain medication. In the Emergency Department, I witnessed every extreme of practitioner and patient behavior. Source: Hubspot
RSQ® Spotlight with Margaret Curtin | Healthcare Risk Management
February 22, 2017
MPIE’s Margaret Curtin Provides Insight into Risk Management’s Role in 2017 As we begin 2017, we asked Michigan Professional Insurance Exchange’s Vice President of Risk and Client Services, Margaret Curtin, MPA, HCA, CPHRM, DFASHRM, CPCU, to share her insight on being successful in the industry and on direction of the industry. Source: Hubspot
Do's & Don'ts of AMA: Patients Who Leave Against Medical Advice
February 20, 2017
As practitioners, we like to think our charm and skills are so valuable that no patient would possibly consider leaving the ED or hospital against our sage medical advice! However, no matter how hard we try or how fast we work, a few patients will always choose to leave before an evaluation is complete—and against medical advice (AMA). Available data shows that about 1.2% of ED patients
4 Key Areas in Your ED that Your Triage Process Impacts
February 15, 2017
Over the last few years, many of our clients have expressed interest in demonstrating the impact that various system-wide performance improvement initiatives might have on patient outcomes or financial metrics. One of our colleagues from a large hospital system recently posed a similar question about triage. Like many initiatives, given there are so many variables in play, it is extremely difficult to pinpoint a cause and effect with triage; however, let’s explore a few areas where
Geriatric Abdominal Emergencies
February 13, 2017
Acute abdominal pain presents a significant challenge to all healthcare professionals who care for geriatric patients. The signs and symptoms may be atypical, the differential diagnosis is vast, the workup is time-consuming, and the stakes are high. It is estimated that of all elderly patients who present to the emergency department with abdominal pain, as many as 50% will require admission and 30%-40% will require surgery. Source:
Common Errors in Chest Pain Diagnosis
February 8, 2017
The chief complaint of chest pain is common among patients presenting to the office, clinic, urgent care or emergency department. While heart disease is the leading cause of death in the U.S., medical error is the third leading cause. Furthermore, missed or delayed diagnoses are responsible for 57% of malpractice claims in emergency medicine, according to a 2007-2013 closed claims analysis from The Doctors Company. This infographic outlines common errors in
Chest Pain Documentation Pearls
February 7, 2017
Patients with chest pain are a common and constant challenge to clinicians, whether in the office, clinic, urgent care or emergency department. The clinical presentations may be confusing, the differential diagnoses are myriad, and not all patients with chest pain will have a serious underlying etiology. Lawsuits involving the care of patients with chest pain are frequent and make up the costliest group of malpractice cases in Emergency Medicine. The cornerstone of high-quality, defensible
Heart Disease Hits Close to Home
February 3, 2017
Heart disease is the leading cause of death for both men and women in the United States. It's responsible for 1 in every 4 deaths. Because of its prominence, we have all likely been touched by this disease. Our staff shares their stories of how heart disease has touched their lives in the hopes of increasing awareness of heart disease. Source: Hubspot
Targeting Obstetrics Malpractice Claims
February 1, 2017
When creating a loss prevention program, obstetrics (OB) is a logical place to focus. It tends to be one of the riskiest specialties in medicine. Here we’ll highlight the research that points to why OB remains a focal point of organizational leadership and discuss the three attributes a loss prevention program in OB should have. Why is Obstetrics High Risk? Source: Hubspot
EMR Documentation Discrepancies Spell Danger
January 30, 2017
The Dangerous Discrepancies One of the most difficult hurdles to overcome during the defense of a malpractice suit is a significant discrepancy in the medical record. The discrepancies may involve the nurses, physicians, advanced practice clinicians, EMS personnel, and any records related to the patient. Often, a discrepancy may be nothing more than a minor difference in terminology; but the cases reviewed here reveal serious discrepancies between the physician and the nurse chart in the first case
The Killer Aorta: Diagnosing Thoracic Aortic Dissection
January 16, 2017
Thoracic aortic dissection (TAD) is one of the most dramatic and life-threatening conditions encountered in all of medicine. Every year in the United States, there are an estimated 6,000 to 10,000 cases of TAD. Since it is an uncommon condition compared to the 5 million ED chest pain visits and more than 1 million acute myocardial infarctions, most physicians have diagnosed and treated only a few patients with TAD during their careers. When combined with a condition like TAD that has such a highly variable presentation, this limited clinical exposure contributes to the potential for delayed or missed
January 12, 2017
Patient experience is an area of healthcare that has a significant impact not only on an organization’s reimbursement, but also on a hospital’s professional liability (HPL) and exposure to litigation. As a result of recent regulatory changes from the Affordable Care Act, it appears that hospitals have become even more judicious in their allocation of resources to various internal initiatives. With this in mind, let’s explore recent evidence that supports a rational, targeted approach for impacting HCAHPS that should lead to an improvement in reimbursement and reduction in liability. Quick Summary of the HCAHPS Relationship to Hospital Value-Based Purchasing
January 9, 2017
Ever since the Institute of Medicine’s report To Err is Human was released in 2000, healthcare has seen a surge in patient safety initiatives. Analysis of medical errors has become increasingly widespread, with several different methods being used by hospitals and practitioners. Of these methods, I suggest that cognitive error analysis may prove to be one of the most valuable in determining the real underlying reasons for medical errors that lead to unexpected adverse patient outcomes. The true origin of an adverse patient outcome may never be discovered for the simple reason that one key question was neither
The Ultimate Loss Prevention Strategy: 4 Key Areas for Allocating Your Risk Management Budget
January 5, 2017
As the healthcare industry constantly evolves and “return on investment” remains a focus, it is becoming more imperative that risk managers allocate their budgets in areas that have the greatest impact on mitigating claims and litigation. Fortunately, The Sullivan Group has the luxury of working with many large, sophisticated, self-insured hospital systems as well as smaller single-site facilities and physician groups. This experience has helped us identify a few key areas that an organization should consider when developing its loss prevention strategy. 1) Focus on Patient Experience Although this topic has been relevant for quite some time, the
The Focus of Patient Safety in 2017
January 3, 2017
healthcare industry will continue to have its radar locked on the issue of Patient Safety in 2017. Some of the targets and goals are only vaguely visible from the 30,000-foot level, while others are in clear focus on the ground before us. Depending on where you stand (or fly), opportunities abound to improve patient safety. Let’s take a forward look into 2017, starting high in the clouds and descending eventually to earth. Soaring at 30,000 Feet: The Current State of Patient Safety In 2015, an expert panel convened by the National Patient Safety Foundation (NPSF) published a report entitled “Free from Harm – Accelerating Patient Safety
Hot Topics: Top 10 Blogs of 2016
December 27, 2016
We've featured a variety of topics, cases, and missed diagnoses on our blog this year, and we hope that you've found the content useful and relevant. In case you missed some of 2016's most popular posts, here are the top 10 articles from the blog this year, according to our website visitor statistics. What was your favorite article? Case: Failure to Diagnose Sepsis Case: Failure to Diagnose Spinal Epidural Abscess Acute Appendicitis: Surgery vs. Conservative Antibiotic Approach Case: Atypical Presentation of Acute Ischemic Heart Disease in Women Every Story Paints a Picture: EMR Documentation of
[Infographic] 5 Ways to Minimize Cyber Risk
December 19, 2016
Download infographic as .jpg. Content provided in partnership with John West, JD, MHA, CPHRM, DFASHRM.
Very Abnormal Vital Signs & Death after Discharge: Remember That Patient You Sent Home Last Night?
December 12, 2016
The majority of malpractice suits in acute care and emergency medicine involve patients who were discharged home. These patients experienced an unexpected adverse outcome after they left the ED such as worsening of their illness or even death. For many of these patients, the “bad outcome” could not have been foreseen — the workup was appropriate, the diagnosis and treatment were correct, and the patient was stable for discharge. A number of discharged patients, however, might have been misdiagnosed and had red flags present at the time of discharge that were either ignored or not recognized. In some
The Deceptive Pied Pipers: “Bedside Maneuvers” for Chest Pain
December 5, 2016
Malpractice claims related to the chief complaint of chest pain continue to plague clinicians. Foremost among these claims is the allegation of “missed MI,” which has now been expanded to include missed unstable angina as well as missed actual myocardial infarction. Although the evaluation of the adult with chest pain is fraught with many pitfalls, one of the most glaring yet avoidable errors is the reliance upon “bedside maneuvers” to exclude the diagnosis of coronary etiology. More than any others, the use of two classic “bedside maneuvers” tends to mislead practitioners and can lead to chest pain malpractice claims.
Case: Failure to Diagnose Sepsis
November 28, 2016
Download audio of this case here. Download case as a PDF here. Sepsis is a regular visitor in the news as cases of flesh-eating bacteria and the dramatic speed with which victims deteriorate hit the headlines. The failure to diagnose sepsis remains a critical issue as delays in diagnosis significantly increase morbidity and mortality. The entire emergency department, urgent care and primary care teams must be focused on early recognition and intervention. This has never been so important as today since evidence now points to interventions that can truly save lives. Today we present perhaps the most challenging of
The Ring of Death: Patient Safety in Radiology
November 21, 2016
It is a routine practice for hospital-based practitioners to order radiology studies during the evaluation of sick or injured patients. The information gained from these imaging studies provides crucial information needed to make a diagnosis and guide treatment. As many as 50% of ED patients get a plain X-ray during their visit. It is well known that utilization of CT has greatly increased over the past decade. The end result is millions of patients in the ED and inpatient units who are transported to and from the radiology department. The appropriate utilization of radiology studies is a topic for
Every Story Paints a Picture: EMR Documentation of Appearance & Activity
November 14, 2016
A few years ago, I invited one of our malpractice defense attorneys to shadow me for a shift in the emergency department. At the end of the day, after he had seen every patient with me and watched me document every chart, I asked him to share any observations. He said, “It shocks me that so little of what you see and do is actually documented.” And I thought my documentation was outstanding! He went on to explain that I captured only a fraction of the information I gathered by observing, speaking with, and re-examining the patients throughout
Veterans Healthcare: What Civilian Physicians Need to Know
November 7, 2016
There are approximately 21 million living U.S. military veterans, and the Veterans Health Administration (VHA) is the largest health care system in the country. Despite its size, the VHA is overwhelmed by the need to provide healthcare to the huge number of eligible veterans. As a consequence of this high demand for care, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014, which allows veterans to seek government-funded care in the private sector under certain circumstances. This act may cause an influx of veterans into private physician practices. The provision of healthcare for veterans, particularly those who
The Chief Complaint of Pain: A Pain for You and Your Patient!
October 31, 2016
A chief complaint of pain is one of the most common encountered by practitioners in any specialty. The pain may be acute or chronic. It may be located in the abdomen, chest, head or any other body part. It may be spontaneous in onset or may be due to an injury. It can range from minimal discomfort to a 15 on the pain scale of 1 to 10. The seriousness of the pain may vary from life-threatening to embarrassingly minor. The patient’s description of pain may be pinpointed and exact or agonizingly vague. Regardless of its characteristics, pain
Trick or Treat? Halloween in the Emergency Department
October 24, 2016
It should be no mystery to anyone that EDs see more than their share of fireworks injuries on July 4th and hangovers on New Year’s Day. But what about on Halloween? Will there be a deluge of patients with candy overdoses? Since I couldn’t recall any specific cases from my own Halloween emergency department shifts, I did a casual search and found a few interesting trends. Halloween is the fourth most dangerous holiday for injuries to children after Labor Day, Memorial Day, and the 4th of July. It turns out that carving pumpkins can be a dangerous activity. The combination
The Electronic Health Record: No Panacea for Risk
October 17, 2016
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” -- President George W. Bush, State of the Union Address, January 20, 2004 The move towards the electronic health record (EHR) has been under way for more than a decade now. Hospital administrators, healthcare insurers, IT vendors and government officials are touting the benefits of transitioning from paper to electronic records. Despite the real and potential benefits, EHRs are no panacea for risk. On the contrary, the transition to EHRs is accompanied by an entirely new set of risks to practitioners and organizations that use
Using Physician Engagement to Improve Hospital Profitability
October 10, 2016
It appeared to be a typical, run-of-the-mill board meeting at Hospital System “X.” Patient admissions had been slowly on the rise; healthcare teams seemed to be handling the increasing demand for services as the hospital facility continued to display an inviting appearance. Early in the meeting, the hospital CFO presented the data requested by board members; suddenly things took a dramatic turn. Several months of data had revealed that a profit drain had developed within the system. And worse news was that month-to-month figures showed this was not just a temporary “blip” in financial performance, but that it had
Cognitive Bias: The Near-Miss Case of “Lazy Boy”
October 3, 2016
Many diagnostic errors involve some degree of cognitive bias or errors; here is an actual case that illustrates this point. Case Presentation L.B. is a 46-year-old man with onset of illness 12 days prior that started with cold symptoms, sore throat, rhinorrhea, cough, and fever up to 100.7°F (38.1°C). Since then, he has been getting progressively weaker, to the point that he could not walk to the EMS vehicle. His past history includes bipolar illness, alcoholism, depression and anxiety. He reports no alcohol intake for 3 months and no complications related to his alcoholism. He was on several medications. He is
September 26, 2016
One of our goals at The Sullivan Group is to bring you practical pearls to reduce risk, improve patient safety, and enhance quality in your everyday practice. To that end I thought I would share with you this “alphabet soup” of risk management and patient safety tips assembled from years of observation and experience. Abdomens and chests are powder kegs. Some of the riskiest problems in medicine live in there! Evaluate patients with abdominal and chest pain thoughtfully and thoroughly. Bandemia is bad. Check the differential on every WBC you order. If you see more than 10% bands, this is
The Year in Review: Important Developments in Case Law
September 19, 2016
There have been some interesting, and some frightening, developments in case law relating to healthcare risk management since the last annual meeting of the American Society for Healthcare Risk Management (ASHRM). While these cases may not have national importance (yet), they have concerning implications for healthcare. In Southern Baptist Hospital of Florida, Inc. v. Charles,¹ the court of appeals in Florida rejected a discovery request for materials that were not protected by “Amendment 7” of Florida law, but that constituted patient safety work product under the federal Patient Safety and Quality Improvement Act of 2005.² The court noted that
5 Tips for Physician Engagement in Practice Change
September 12, 2016
Physician engagement is sometimes cited by organizations as a challenge on its path to implementing a successful practice change initiative. Below are five tips for engaging physicians using continuing medical education (CME): Identify the goals of your organization/physician leaders and align education with those goals. Understand the physician population you are trying to engage and select formats that appeal to them. Buy-in is achieved best when the knowledge is coming from a reputable colleague. You can also create incentive programs (i.e. gift cards, premium discounts or credits, department participation
The Promise of the Electronic Medical Record
August 30, 2016
A Promise Unfulfilled What exactly was the promise of the electronic medical record? The tool that was supposed to make life easier, workflow faster, quality of care better, and patients’ lives healthier has pretty much turned into a face-plant; a promise unfulfilled. Although there are some notable exceptions, the market has shifted to the large electronic health record companies, and medical record content and speed and quality are not their highest priority. Physician satisfaction with these instruments is abysmal. The Road Ahead for Electronic Medical Records What should the EMR do for practitioners, and even more importantly, for our patients? The
Case: Failure to Diagnose Spinal Epidural Abscess
August 29, 2016
Failure to diagnose is the most common medical error in the practice of emergency, urgent care and primary care medicine. Spinal epidural abscess (SEA) is one of the most difficult conditions to diagnose, but there are common threads among failure to diagnose spinal epidural abscess cases. This case is presented to provide perspective and to increase our vigilance for catching this disabling and possibly even fatal diagnosis.
Obstetrics: Delays in Treatment of Fetal Distress
August 23, 2016
Malpractice claims continue to plague the specialty of Obstetrics. In the 2015 ACOG Survey on Professional Liability, a total of 4,294 physicians responded; 73.6% had at least one claim filed against them during their careers. There were 1,117 total claims reported by the surveyed OB-GYN physicians, with 63.5% of these claims involving obstetric care, and the remaining 36.5% involving gynecological care. Malpractice Claims Prompt Changes in Practice Nearly 50% of the survey respondents indicated they had made changes in their OB practice “as a result of the risk or fear of professional liability claims or litigation.” Most of these changes
Hospital Triage: An Under-Appreciated Risk?
August 17, 2016
Triage is an essential part of any busy emergency department (ED), but one that is often taken for granted. While triage is not designed to determine the cause of the patient’s symptoms, it prioritizes the patient’s need to be seen by a provider. EDs often assume (possibly erroneously) that triage assessments are being performed correctly or that any errors in triage can be corrected when the medical screening is done. Both of these assumptions can lead to serious adverse patient events. There are two potentially significant problems that a faulty triage process can introduce into the ED: (1) delays
Necrotizing Fasciitis is Still Lurking Out There
August 8, 2016
The uncommon but lethal infection known as necrotizing fasciitis continues to be in the news. This is a devastating disease that can be difficult to diagnose in the early stages. The first presentation is often nothing more than arm or leg pain that looks very much like garden-variety musculoskeletal discomfort. By the time the diagnosis is made, the disease process is often too far along to reverse it, resulting in severe disability or death. However, there are usually a few clinical clues that a more dangerous process is under way. Consider the following case of necrotizing fasciitis to identify
3 Pediatric Heat-Related Illnesses
August 1, 2016
The temperatures are rising, and school sports are starting long practices in all kinds of weather. During intense exercise, people can lose up to 1.5 liters of fluid per hour. Summer is prime time for pediatric patients to sustain heat-related illnesses, and these patients may present to the emergency department in some distress. Defining the components of and differences among heat-related illnesses is quite important. While only heat stroke is a true medical emergency, the following is a breakdown of the three most common heat-related illnesses that present to the emergency department: Heat Cramps Heat cramps are characterized by sudden and
Spinal Epidural Abscess: 5 Things You Should Know
July 25, 2016
The incidence of spinal epidural abscess (SEA) has doubled in the past 2 decades due to the epidemic of MRSA infections, the spread of IV drug use, and the increased number of spinal and vascular access procedures. Delayed or missed diagnosis of SEA leads to profound disability or death; lawsuits in this arena are exceptionally costly. 5 Key Things You Should Know About Spinal Epidural Abscess The "Classic Triad" of back pain, fever and neurologic deficit is present in less than half of patients with spinal epidural abscess. Fever is only present in about 50% of SEA cases,
July 18, 2016
Most predicaments in which James Bond finds himself require clever improvisation to achieve a good outcome. Bond knows that every mission entails huge risks that are largely unpredictable. In contrast, the risks of surgery are recognized in advance, and the procedures go according to plan in the vast majority of cases. Despite proactive safety measures, claims against surgeons continue to occur regularly for bad outcomes. It has been estimated that approximately 80 surgical never events occurred each week between 1990 and 2010. Below are tips & tools to avoid the following four common issues in surgery safety: Informed consent
Patient Experience: How to Interact with a Patient
July 11, 2016
Patient experience has emerged as one of the most important aspects of medical training in today’s healthcare environment. Patients are not only demanding satisfaction in their experience, they are researching hospital and provider satisfaction ratings to make sure others have had a positive experience prior to seeking medical care themselves. In today's age, your patients will judge you not by how well you do on your board exams, but on how they perceive you on providing compassionate and competent care to them. These videos examples can provide insight you can apply to every patient you see to allow you to develop consistent
10 Secrets About Bites and Stings
July 4, 2016
The majority of animal and insect bites and stings are harmless and can be managed at home. However, there are many that can cause a medical concern, some more acute than others. Read these 10 secrets to brush up on your approach to the patient who presents with a bite or sting this summer. Most rabies cases in the U.S. are caused by bats. Skunk, fox and raccoon bites can also transmit rabies to people. Groundhogs are the only rodents that transmit rabies. Chipmunks, mice, rats, rabbits and squirrels usually die before they can infect humans. The
Communication Breakdowns in Healthcare: A Significant Cause of Risk and Malpractice Litigation
June 27, 2016
“It’s all about communication!” The world of medicine has changed by leaps and bounds over recent decades. Computers have become part of our daily lives, and technological advances have significantly improved our ability to diagnose and treat diseases that were once thought incurable. Despite this incredible progress, healthcare providers continue to commit far too many medical errors. And unfortunately, many of these mistakes are simply caused by “poor communication.”
Violence in Healthcare Part 2: Prevention and Intervention
June 20, 2016
Violence in Healthcare Part 1: Risk Factors & Warning Signs Once you have an understanding of the risk factors and warning signs that may lead to workplace violence in a healthcare setting, it’s imperative to implement a plan to prevent and intervene in these situations to provide a safe environment. Environmental Intervention A number of environmental interventions can reduce the risk of violence to healthcare providers. These measures can help healthcare workers safely and effectively manage possible assaults. Create calm, quiet environment that is nurturing and healing. Avoid pointing a finger or making a fist. Use verbal intervention with scripts. Stay
5 Low Back Pain Diagnoses You Don’t Want to Miss
June 12, 2016
Only the common cold prompts more people to see a practitioner than acute low back pain. Most people will suffer with low back pain at least once in their lives, and it is estimated that 2% to 3% of all ED visits are for acute non-traumatic back pain. With costs exceeding $90 billion per year, the far-reaching implications are clear. Acute low back pain affects men and women of all ages; it is a common cause of disability in those less than 45 years of age due to work-related injury. Patients experience pain and lost wages; employers are
Violence in Healthcare Part 1: Risk Factors & Warning Signs
June 6, 2016
Pinched, pushed, punched, or even stabbed, shot or killed. Nearly every healthcare worker has been a victim or knows a coworker who has been a victim of workplace violence. Workplace violence represents a serious health and safety concern for all employees, but healthcare workers in particular face significant risk. Health and social service industries account for 48% of all non-fatal injuries from occupational assaults and violent acts. In a recent study, one in ten nurses reported being physically assaulted in the past year, and five in ten nurses reported being threatened or verbally abused. In addition, workplace violence was rated
Principles of Informed Consent in Healthcare
May 31, 2016
Many practitioners view the process of informed consent in healthcare to be a nuisance and a hindrance. It is often simply one more hoop to jump through so that the patient can get the care he or she needs. This is not true. If the provider was negligent in providing the service and a bad outcome occurred, the patient has a cause of action for medical malpractice. If the provider was not negligent but a bad outcome still occurred, the patient may have a cause of action if the provider did not disclose the risk of the bad
Confessions of an Antibiotic Abuser
May 23, 2016
The discoverer of penicillin, Sir Alexander Fleming, warned many decades ago that the “public will demand [the drug and]…then will begin an era…of abuses.” His prophecy has been realized, and I readily confess that I am guilty. During my 37 years in family practice and emergency medicine, I admit that I prescribed antibiotics for viral and self-limited illnesses. There were times when I bowed to pressure from ill and desperate (but not desperately ill) patients or their parents who demanded a cure for an upper respiratory infection. At other times I was simply too tired to carefully explain,
Case: Atypical Presentation of Acute Ischemic Heart Disease in Women
May 13, 2016
A 35-year-old female presents at 0321 by ambulance with a complaint of chest pain. The records show EMS arriving at her house and finding the patient on the couch. Download Audio Case Review Download as PDF EMT Notes Patient appears to be anxious and hyperventilating. Encouraged patient to slow breathing down. VS obtained: Pulse 120; BP 152/112; Resp. 22, shallow. Patient complains of: intermittent sharp chest pain located in sternum area non-radiating; started at 0230. Pain is 8 on a scale of 1-10. Patient also complains of an increase in pain upon palpation to the sternum and with coughing. Patient
Common Barriers Interfering with Triage Practice Change
May 9, 2016
After investing in a triage education program, some emergency department (ED) managers and educators become frustrated due to gaps in the application of that education. Implementing practice change does not always come easily, especially for those who have operated according to certain protocols for several years. The following are some of the common barriers that can interfere with the application of updated triage practices: Practicing with providers/peers who lack knowledge of triage standards. ED staff members who are unaware of the implementation of new triage criteria by their organization might prevent nurses from following or adopting the new scoring
The Diagnostic Process: Rediscovering the Basic Steps
May 2, 2016
Arriving at the correct diagnosis sometimes follows a short and simple journey. Consider the classic case of shingles, for example, where the one-step process consists of recognizing the tell-tale pattern of vesicular lesions. Contrast the rash of shingles with the more elusive symptoms of chest pain, headache, or weakness, which usually require a multi-step approach to reach the correct conclusion. As clinicians, we were all taught the “diagnostic process” in some shape or form. What we didn’t always learn is that each step in the process is accompanied by potential missteps that can take us down the path
April 25, 2016
The possibility of cyber liability (the threat of liability due to unlawful access to electronic data) has been in the news recently. The reports of security issues include losses by large and small providers. Based on the reports in the media, it would appear that no one is immune to this threat. While there can be no guarantee of immunity, there are things that healthcare providers can do to reduce the threat of loss. [Infographic] 5 Ways to Minimize Cyber Risk The first step is good, old-fashioned physical security for devices that store electronic data on patients and employees.
First Impressions are Critical to Patient Experience
April 19, 2016
All of us experience a never-ending number of first impressions. Consider that first visit to a restaurant highly recommended by friends. After being seated, five or ten minutes go by without a waiter coming to the table. When the waiter does arrive, they seem distracted with no discernible facial expression. How does this indifference make you feel? Or what about the flight attendant who treats you like an empty seat when you try to ask a simple question? In either case, the chance for a warm, enjoyable experience disappears after such a cold beginning. The same is true for
Malpractice Claims or Medical Errors: Which One is the Real Target?
April 4, 2016
Is there a reliable way to predict which physician will be sued for malpractice? Researchers, insurers and healthcare professionals have wrestled with this question for decades. A recent study in the New England Journal of Medicine and a follow-up response by the Physician Insurers Association of America (PIAA) provide more data points, but admittedly do not answer the question definitively. Perhaps they are trying to answer the wrong question. An NEJM study of paid claims reported to the National Practitioner Data Bank (NPDB) concluded that about 1% of all physicians accounted for 32% of paid claims and that the
March 28, 2016
A 78-year-old man, Mr. S, came to the emergency department with the chief complaint of abdominal pain. He was an active person, residing in the independent living section of a retirement complex. He described the pain as an ache in the mid and lower abdomen that had been present for several days. The pain did not radiate. He denied any fever, nausea, vomiting or diarrhea. He claimed having no appetite or bowel movement “for days.” The exam showed him to be uncomfortable, with unremarkable vital signs. Palpation of his abdomen revealed distention and moderate tenderness below the umbilicus. There was no appreciable guarding, rigidity
Acute Appendicitis: Surgery vs. Conservative Antibiotic Approach
March 21, 2016
There is a new risk and safety issue in the world of appendicitis. In this issue of TSG Quarterly, we explore the issue of conservative, antibiotic-first management of acute appendicitis with appendectomy reserved for treatment failures. Is it the new standard? Have you proactively addressed this issue with your emergency medicine and surgical practitioners? It is important to get out in front of this issue to keep our patients safe! Download this case as a PDF here. Consider the following fact pattern: A 40-year-old woman presents to
Creating a Patient Safety Culture
March 14, 2016
Current strides in improving patient safety in hospitals and medical facilities provide clear evidence that the healthcare industry has the capacity for meaningful change. However, providers continue to face significant obstacles; perhaps the biggest obstacle of all revolves around developing and expanding a vigorous “safety culture.” Indeed, much of the focus has been on technology and incremental process improvement, but building a “culture” is the foundational contributor to ensuring patient safety. A recent report by the National Patient Safety Foundation (NPSF), Free From Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human, acknowledged that “patient safety
An Overview of Pediatric Malpractice
March 7, 2016
The practice of pediatrics is relatively unique from a risk management perspective. One study placed the risks associated with the practice of pediatrics relative to other specialties as 25th out of 26 specialties with regard to the risk of being sued. However, although the risk of being sued is relatively low, another study found that the risk that a pediatrician may be sued in a given year was 3.1% as compared with 7.4% for all physicians. In the first study, the mean indemnity payment for all physician specialties was $274,887; the median was $111,749. For pediatricians, comparable figures
Thoracic Aortic Dissection: The Great Masquerader
February 29, 2016
Not all chest pain is a heart attack. While acute coronary syndrome (ACS) may be the most common serious cause of chest pain, clinicians must keep other dangerous conditions in the differential diagnosis and eliminate the possibilities based on the patient’s history, risk stratification, physical exam and diagnostic testing. One of the most dramatic and perplexing causes for acute chest pain, other than ACS, is thoracic aortic dissection. Thoracic aortic dissection (TAD) is a Great Masquerader. It can present with symptoms extending from head to toe and can mimic ACS, TIA or stroke, back strain, abdominal catastrophes and extremity
Shifting from Triage Audit to Critical Thinking Opportunity
February 22, 2016
As leaders in the healthcare industry, we spend a great deal of time and resources analyzing patient outcomes and looking for areas of improvement. In triage, this typically translates to a leadership audit of triage decisions and a report back to staff on areas of improvement. It’s important to periodically evaluate your audit process for effectiveness and sustainability. To evaluate your current process of triage record reviews, consider the following: What practice changes are indicated based on the results of the data? Are the data specifics targeting areas of safety and practice standards compliance? What percent of staff change their triage decision-making
7 Strategies to Reduce Hospital Readmissions
February 16, 2016
Preventable hospital readmissions cost taxpayers billions of dollars each year. As we move further into the age of healthcare reform, practitioners will feel rising pressure to reduce costs and decrease unnecessary and preventable re-hospitalizations. Providers cannot and should not avoid the readmission of patients when medical or surgical situations require inpatient care. However, a fair percentage of unintended readmissions can and will be reduced by implementation of initiatives that not only improve quality, but support patients as they transition through the care continuum. Let’s examine 7 strategies to reduce hospital readmissions: Strategy #1 - Understand Current Policy
Heart Disease in Women: Underdiagnosed and Undertreated
February 8, 2016
February is American Heart Month 2016 and an appropriate time to recognize the recent reduction in mortality rate from cardiovascular disease in women. The increased awareness of women and healthcare professionals has resulted in better care and is at least partially responsible for the lower death rate from heart disease seen over the past decade. However, the battle against women’s heart disease is far from over. Awareness has improved, but the realities of heart disease in women remain underappreciated even in 2016. The American Heart Association has just published the first Scientific Statement on Acute Myocardial Infarction in
Diagnostic Error: Chaos or Conquerable?
February 3, 2016
Given that proven effective solutions exist today, why haven't more institutions implemented programs that have proven to reduce diagnostic errors? I listened with great interest to the interview conducted by Dr. Robert Wachter with Dr. Mark Graber in the January 2016 podcast of “Perspectives on Safety,” also published in the AHRQ PSNet. Dr. Graber makes an excellent point that the data regarding diagnostic errors are statistical estimates based on extrapolation from claims data and a few other sources. We don’t really know the true scope of diagnostic errors. What is worse, the individual physician struggles to understand just what
Key Considerations When Funding a Patient Safety Program
January 27, 2016
Funding a patient safety program can be challenging, especially when the return on investment is constantly under scrutiny. While the ultimate goal of your program is safer care of patients, there are also measurable financial benefits that result from reduction in claims and malpractice litigation. Professional liability carriers, whether commercial or self-insured, also have a vested interest in your patient safety measures. Depending upon how your organization insures its HPL/MPL coverage, there are several options for funding your patient safety program. Commercial or Self-insured Professional Liability Insurance? Commercial Carrier –
Iowa Passes Comprehensive Disclosure Law
January 20, 2016
A recent Ob.Gyn. News article reported that the State of Iowa has joined Oregon and Massachusetts in passing a comprehensive disclosure law. The apology laws from these three states go beyond the simple immunity for empathy or apology that exists in 36 other states. Instead, they lay the foundation for the development of actual disclosure programs that help consumers and clinicians communicate and resolve differences post-event, including compensation for serious harm or death caused by malpractice. In exchange for confidentiality from the courts as well as regulatory
Avoid Readmissions vs. Death After Discharge
January 13, 2016
It is certainly a good idea to avoid readmissions that are deemed unnecessary. However, from the vantage point of risk and patient safety, the sword of readmissions reduction has another sharp and dangerous edge. Plain and simple, along with sensible system solutions, there will be irrational but powerful pressures exerted on the gatekeepers of inpatient admission to send sick patients home rather than readmit them. How many emergency physicians have felt the pushback from an admitting physician when a sick patient who clearly needs to be readmitted for the same diagnosis returns to the hospital within 30
How to Improve on the HCAHPS Patient Satisfaction Survey
January 5, 2016
The patient satisfaction survey, HCAHPS, reflects patients’ perspectives of their hospital experience. The survey results are used to compare hospitals to each other using measures that are significant to healthcare consumers. HCAHPS scores are used by CMS to determine a slice of reimbursement to hospitals, making up 25% of a hospital’s Total Performance Score in the Hospital Value-Based Purchasing program for 2016. Apart from these important fiscal repercussions, what everyone really wants to know is, “How can we improve our HCAHPS scores?” Communication is critical. After analyzing 3.1 million HCAHPS surveys, CMS reported that strong communication is correlated with
Case on Batch Medical Incidents: Catastrophic System Risk
December 9, 2015
The following case is from an online CME course by Dan Sullivan, MD, JD, FACEP. The course, Batch Events - Catastrophic System Risk, explores the question: What is a batch medical incident or claim and why read a course on this subject? Batch medical incident is a term coined by the insurance industry to recognize and manage a certain type of legal claim. But the concept of the batch incident or batch event is incredibly important for all health practitioners and medical system leadership, and it is not often addressed in patient safety and risk reduction education. This is an
Why a Better Patient Experience Now?
November 30, 2015
Providing a better patient experience continues to challenge hospitals and other medical facilities, despite: The numerous national conferences examining this issue and proposing means to better achieve it; The countless newspaper stories, magazine articles and blogs discussing this over the past several years. What prompted this deluge of interest? The Main Catalyst: The Affordable Care Act Hospitals were traditionally rewarded by CMS for the number of Medicare and Medicaid inpatient discharges from their facilities. However, the Affordable Care Act introduced new performance standards, demanding that better quality of care
RSQ Collaborative Semi-Annual Gathering Recap
November 24, 2015
In pursuit of our mission to improve patient safety and reduce risk, The Sullivan Group (TSG) held our semi-annual gathering of the Risk, Safety, and Quality (RSQ™) Collaborative in mid-November. The RSQ Collaborative, formed in 2010, is an elite group of nationally and internationally recognized clinical champions that share TSG’s passion for reducing medical risk, the frequency of medical errors, and ultimately saving patient’s lives. The most rewarding part of these gatherings is brainstorming with the group to identify new and creative ways to deliver practical, scalable solutions that change clinician behavior, increase quality of care, and decrease the
Evidence-based Medicine: What’s the Buzz?
November 10, 2015
Healthcare is all abuzz about evidence-based medicine (EBM), and legions of clinicians are struggling with how to incorporate EBM into the new paradigm of providing the safest possible high-quality healthcare in the most efficient manner. Evidence-based Medicine: Origins and Definition The term "evidence-based medicine" was coined over 20 years ago by a group of physicians who believed the care that patients receive should be based on the best science available at that time. Actually, this concept was first called “science-based medicine,” but not surprisingly, that name did not get much traction. Now this concept is firmly rooted internationally in medical
IOM’s Call to Arms for Failure to Diagnose
November 3, 2015
Fifteen years ago, the Institute of Medicine (IOM) published a landmark report “To Err is Human: Building a Safer Health System.” The IOM shocked the world revealing that up to 98,000 humans may die each year as a result of medical errors. That actually came as no surprise to those of us dedicated to patient safety and medical error reduction for the last two decades. As a healthcare provider, one need only pay attention to see that the frequency of errors is obvious. As a healthcare worker with a family member in the hospital, a tally sheet is
Prevention and Treatment for Stroke
October 28, 2015
Prevention and Treatment for Stroke World Stroke Day, established by the World Stroke Organization in 2006, is observed worldwide on October 29 to underscore the serious nature and high rates of stroke, raise awareness of the prevention and treatment of the condition, and ensure better care and support for survivors. Stroke has emerged as one of the most significant quality, risk and safety issues of the 21st century. Consider some of the numbers: Each year about 795,000 people experience a new or recurrent stroke in the United States. About 610,000 are first strokes; approximately 185,000 are recurrent attacks. Stroke is the
The New Healthcare Imperative: Clinical Transformation
October 22, 2015
This presentation will be a bit of a departure from our typical clinical case presentation-discussion format. But the time has come to offer a look at the medical marketplace from 20,000 feet, how healthcare organizations are responding, the regulatory changes that are tied to clinical performance, and the support TSG provides to facilitate this clinical transformation to achieve success. It’s not just hanging out the shingle anymore! Change is afoot! The Pulse of the Industry Change in the medical marketplace is not incremental, it is transformational; it is a sea change. Those
CMS Programs that Impact Healthcare Reimbursement
October 14, 2015
Clinicians play an integral role in leading the adoption of CMS regulatory changes. What follows is a summary of program updates for FY2017 that will impact healthcare reimbursement. Value-Based Purchasing Program: The Value-Based Purchasing (VBP) Program for FY2017 (with performance period of 2015) will focus on several domains: Clinical Care - This metric for FY2017 will be monitoring clinical processes related to Acute Myocardial Infarction (e.g. lytic therapy within 30 minutes); influenza immunization; and OB (elective delivery prior to 39 weeks gestation). The Outcomes Domain will fall under the Clinical Care Domain and will monitor the 30-day
November 12, 2014
Are you prepared for surges in your ED patient volumes? As we head into the peak of flu season, many facilities are already feeling the effects of increased volumes, such as: Longer waiting times Staff exposed to more airborne illnesses resulting in increased sick time A shift in perceptions of care resulting in lower patient satisfaction scores In addition, the Patient Protection and Affordable Care Act (ACA) is expected to result in a surge in patient volume, and there is no way to determine those numbers. Millions of people are expected to enroll in a health insurance plan, many for the first time.
Top 5 Tips on Physician Engagement
October 31, 2014
What Are You Doing to Engage Your Physicians? Here are some tips on engaging physicians using CME: Identify the goals of your organization/physician leaders and align education with those goals. Understand the physician population you are trying to engage and select formats that appeal to them. Buy-in is achieved best whenthe knowledge is coming from a reputable colleague. You can also create incentive programs (i.e. gift cards, premium discounts or credits, department participation awards/contests, poster display of power users/top performers in break rooms, etc.) to increase participation. Provide leadership training to create
A Distressed Labor & Delivery Unit
October 25, 2014
Scenario: Dr. Mary Smith, the Chair of the Obstetrics and Gynecology department at County Hospital, was en route to a meeting with Dr. John Bart, Chief Medical Officer. The purpose of the meeting was to review patient complaints originating out of her service. While waiting for the elevator, Dr. Smith was hurriedly approached by an obviously distressed Susan Jones, the Labor & Delivery head nurse. "We had another bad outcome last night,” said the head nurse. “We had to send another baby up to the NICU.” "What happened?" asked Dr. Smith. "We had one of our new grads taking care of the patient
