Vickie: This is Laura Tucco, Certified Legal Nurse Consultant. Laura specializes in emergency cases. Laura, I know that there’s a huge incidence of visits to the emergency department (ED). Let’s talk about that because that’s obviously what sets the stage for this being such a highly litigated area. So many people go to the ED.
Vickie: I know one of the big reasons that emergency departments are at risk legally is because, to the patient coming in, they’re often being treated, by what we call in the legal world, anonymous providers – providers that they don’t have these long-standing relationships with. So when things do go wrong, the patient is quick to sue. Whereas, if a patient has visited their family practitioner they’ve seen for 10 years and has an issue, they might be a little more forgiving. Do you want to talk about that?
Laura: One of the things that contribute to a good outcome with patients is so basic, and that’s the relationship that you have with the patient. That’s the major contributor to patient satisfaction. It’s that communication pattern. When these patients come into the emergency room they are being taken care of by people that don’t know history, don’t know them and maybe have no access to the medical records. So it fosters a lot of potential problems in the care of that patient and creates the possibility for many errors.
Vickie: That can make the provider feel kind of vulnerable.
Laura: Absolutely. The providers have to make split-second decisions. They’re often caring for many patients at the same time. There are so many factors at play in the emergency room, that it’s really an area where you have multiple contributing factors in these cases.
Vickie: And emergency nurses have to be knowledgeable in so many areas because they’re dealing with every type of emergency, right?
Laura: As I always say, you have to be a jack of all trades and a master of none because you have to know a little bit about everything and not a whole lot about anything. Patients are going to do well in an environment where there are very experienced staff. In the emergency department-related legal nurse consultant jobs I review I look at how long the healthcare provider has been an RN. How long has she worked in the emergency department? What kind of training does she have? It is such a complex area that patients are cared for differently depending upon the qualifications of the provider.
Vickie: When you’re actually analyzing emergency department-related legal nurse consultants jobs that’s very important and I’m glad that you brought that up. You’re looking at the experience of the nurse who was implicated.
Laura: Right. I look at – What is her license? How long has she been working in the department? Other things to look at include additional training such as ACLS and trauma courses. The Emergency Nursing Association (ENA) has many courses and so you look at the timing of the additional training that is specific for emergency care and whether those credentials are maintained, and who monitors them and what does that department require them to have to work there.
Vickie: Of course it can be a pretty chaotic place and the pace is fast. Do you want to talk about that and how it creates a setup for potential litigation and risk?
Laura: You have care providers coming and going at all times of the day. Typically you have shift changes at 7:00am, 11:00am, 3:00pm, 7:00pm, 11:00pm. The physicians may change at different times so they’re not all changing shift at the same time. You have patients coming in 24 hours a day and those ERs never close. You can have unlimited numbers of patients, both ambulatory and ambulance arrivals. It’s a very chaotic environment, staff often work long hours, there are varying levels of qualifications to work in the emergency department so there are many, many different factors at play. And you have varying acuity levels, so you have people that are not very ill all the way up to people that are in life-threatening conditions so you have to be very adaptable and change very quickly to what is coming in the door.
Vickie: We know triage is obviously a big issue in emergency department-related malpractice cases. What are some of the other big emergency issues that you see when you’re consulting?
Laura: Most cases are not just one thing contributing to the bad outcome for the patient. Usually I find a whole constellation of problems. It’s not necessarily one negligent act that occurred, it’s many different things coming together to create problems. It can be nursing issues, it can be physician issues, there can be issues related to transferring the patient within the facility or to another facility. It can be issues of absolute error, medications errors occurring in the emergency room. It can be that no one’s recognizing that this patient is septic. They have a cough, they have a slight fever, they have a rash or they have diarrhea and it’s a child, nobody pays attention. They think it’s just a sick kid, but in fact the child is septic. You can have atypical presentations and that catches people off-guard. Patients are moving at all times, you have patients going to x-ray and back, and you have lots of stuff going on all at the same time. So many different factors contribute to bad outcomes for patients in the emergency room.
Vickie: The emergency department is such a different environment that I know I would definitely subcontract with an emergency specialist like yourself for emergency department-related legal nurse consultant jobs. But for anybody else out there who is listening, what should they do?
Laura: Keep an open mind. Look at all of the medical records. You may not have many records to look at or you could have volumes of records to look at. But even if there aren’t a lot of records, look at basic stuff because it’s often basic stuff that’s important. Not adequately assessing the patient, not adequately monitoring the patient and nobody is really putting all the pieces together to recognize “Oh wow! This is what’s going on.” Certified Legal Nurse Consultants can do this, but for some of the nuances of the department, that is where your CLNC® subcontractor who is a specialist should come in.
Vickie: Great advice! Thank you so much Laura.
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