Emergency departments see it all. They are almost always busy these days. They may be short on staff or at least not have enough staff and beds to deal with the volume of patients they see. All of this makes them a place where malpractice can more easily occur.
Have what you think might be a medical emergency? Head to the local emergency department. Once there you may find yourself waiting along with many other sick or injured people for a doctor to see you. Not all of the people waiting will have real emergencies. Even among those with real emergencies, those in most need of immediate medical treatment must be identified and seen first. The process of identifying those patients most in need of care is called triaging. It is one of the first things in the emergency department that can go wrong and lead to serious injury or death.
If you have ever been to an emergency room for yourself or with a friend or relative, you have probably been asked some questions when you arrived and then told to take a chair and wait for your name to be called. The questions at this stage are intended to identify those who need treatment right away. Think crushing chest pain in an older person, or stroke symptoms, or heavy bleeding. Unfortunately, sometimes poor decisions are made by the staff asking the questions and deciding the order of treatment. I have had clients who came to the emergency department because of chest pain, were told to wait and then collapsed in the waiting room from a massive heart attack. Even when you get into a treatment bay, someone may arrive at the hospital who needs treatment more urgently than you and you must continue to wait.
Once you are taken back and have the attention of the doctor, the process of determining the problem and beginning treatment can begin. Keep in mind, however, that the emergency room doctor is working at a disadvantage that can have serious consequences. This doctor has likely never seen you before. She or he does not have the advantage of any history with you or access to your medical records. If you cannot give your own history, the person giving the history on your behalf may not be very knowledgeable about it, if there is even someone who can give a history at all. It is not uncommon for an emergency department physician to be asked to treat a patient who was found unconscious on the street. No one knows who the patient is or what the patient’s problem might be. Even when you or your friend can give a history and describe the problem that brought you to the emergency department, communication may be hurried or there may be language problems or gaps in the information. Even under the best of circumstances, the doctor may be rushed or tired and those conditions lead to mistakes.
You are not home free by any measure once the doctor has taken your history and reached a tentative diagnosis. In the first place, for many of the reasons listed above and many not listed, the doctor may misdiagnose you. This can lead to no treatment or the wrong treatment. Even when the diagnosis is correct, there may be errors in administering the correct treatment.
Communication is a difficult issue throughout the hospital. In the emergency department miscommunication happens with some frequency because of the chaotic nature of what goes on there. Orders may be misunderstood and patients may be misidentified.
Keep in mind that it is not the job of the emergency department doctor to treat whatever brings you to the emergency department. Her or his job is to identify emergencies, stabilize you and get you the ultimate care you need. This may involve a referral to a doctor after you have been discharged from the emergency department or may involve getting another doctor to agree to admit you to the hospital. Emergency room doctors do not have the authority to admit patients to the hospital. A doctor with privileges at the hospital must agree to admit you and to be responsible for your care.
Even if everything goes smoothly up to this point and a doctor with privileges at the hospital has agreed to admit you and to assume your care, there may not be a hospital bed immediately available for you. This will require you to be “boarded.” You will have to remain in the emergency department until a bed becomes available. Under even the best of circumstances, this is not optimal. While in the emergency department, you are not going to get the nursing care and monitoring you would expect to receive once you arrive in your regular hospital room. The nurses in the emergency department have other responsibilities and it was never intended they would provide routine nursing care to admitted patients. If your condition deteriorates, as it may, no one may notice. This is when it is important to have someone with you, if possible, to be your advocate in the event things do not go as planned.
All in all, the emergency department is a necessary place but one you want to get out of as soon as possible. You want to get in, get treated and either get discharged with an appropriate treatment plan or get admitted and get to a hospital bed. The longer you are in the emergency department, the greater the risk something will go wrong.
