Malpractice Consult: Your Liability for ED Patients

Article excerpt

Admit a patient to the hospital based solely on a verbal report from the ED physician? You may already have. And if you haven't, you may soon.

Most hospitals won't allow ED physicians to admit patients because they want to avoid confusion regarding who will be the patient's attending physician for the inpatient stay. So if an emergency physician calls to inform you that one of your patients is in the ED, what's the best wayfrom patient care and liability perspectives-for you to respond?

Start by determining whether you have enough information to write orders and develop an initial plan of care without seeing the patient. You may decide that you need to come in and evaluate him before giving any orders. Even if you don't make a trip to the ED, once you take the emergency physician's call, agree to admit the patient, and give orders, you're the patient's primary attending and potentially liable for the care provided.

More to the point, can you be held liable for an adverse outcome if you wrote orders based on incorrect or incomplete information provided by the ED physician? Possibly, because while the ED record may contain a lot of data about the patient, there's often no clear documentation of exacdy what the ED physician told you. As often happens, a malpractice lawsuit will name every physician who was involved in the patient's care-even indirecdy-and the plaintiff's attorney will attempt to convince a jury that you were aware of everything that, in hindsight, turned out to be significant.

There are a couple of things you canand should-do to reduce your liability risk when your patients need emergency care.

First, come to the emergency department and see the patient as soon as possible. Obviously, very sick and unstable patients should be seen immediately.

Second, when you see the patient, write a thorough progress note that includes significant findings that weren't previously relayed to you, or that differ from what you were told. Don't write the note in an accusatory manner because the patient's condition might have changed between the time the ED physician spoke with you and when you saw the patient. …