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Lawsuits may arise from ED 'boarding' practice
An emergency physician is managing an acute myocardial infarction, arranging for a patient transfer, sewing up a laceration, and putting in a chest tube, with 20 people still waiting to be seen in the waiting room. This is probably not the best person to provide routine inpatient care for multiple patients being held in the ED, says William Sullivan, DO, director of emergency services at St. Mary's Hospital in Streator, IL.
"Chances are that it's been a while since an emergency physician has ordered a colon preparation prior to a patient's colonoscopy or done an in-depth work-up to determine the cause of a patient's anemia," Sullivan says. "Those just aren't things we routinely do. Having admitting physicians handle admitted patients is better for patient care."
Holding admitted patients in EDs always was known to be bad for patient flow, but there is a growing body of research showing that it also harms patients.1-4 There's no question that the risk of a poor outcome increases when patients board for long periods, particularly when those patients are critically ill, according to Jesse M. Pines, MD, MBA, MSCE, assistant professor of emergency medicine and epidemiology at the Hospital of the University of Pennsylvania in Philadelphia. "In many hospitals, it is the ED physicians and nurses caring for these boarders, so the risk falls squarely with them," Pines says. "It may be impossible to avoid getting roped into lawsuits if there is an error attributed to boarding."
When a bad outcome does occur, attorneys will scour the chart to see what happened while the patient was boarding. "This is especially true now that there is clear evidence that boarding is hurting people," he says.
ED leadership must be patient advocates, says Robert Broida, MD, FACEP, chief operating officer of Physicians Specialty Limited Risk Retention Group, the professional liability insurer for Canton, OH-based Emergency Medicine Physicians. His recommendations: