[Analysis of the knowledge and practices of health care workers in Emergency Departments regarding the protection and preservation of evidence in forensic cases]

BACKGROUND

The frequency of violent incidents is increasing. This increase has made the role of Emergency Department (ED) staff more important in the collection, recording, protection, and storage of the evidence until the arrival of the responsible people concerned with the issue. Therefore, this study was designed to analyze the knowledge and practices of the nursing staff working in the EDs with respect to the protection and preservation of the evidence in forensic cases.

METHODS

This research, which was designed to be descriptive, was conducted with 44 health care workers in the hospitals with Emergency Departments in the center of Bolu province between October 2008 and January 2009.

RESULTS

It was observed that 90.9% of the health care workers encountered forensic cases, 65.9% of them had not attended any training on forensic cases, and 22.7% of them did not use care when removing and storing the clothes of the patient. It was considered that 90.9% of the health care workers duly carry out their duties and responsibilities in forensic cases; however, 18.2% of them do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.

CONCLUSION

It was observed that most health care workers do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.

Hospice care and the emergency department: rules, regulations, and referrals

Emergency clinicians often care for patients with terminal illness who are receiving hospice care and many more patients who may be in need of such care. Hospice care has been shown to successfully address the multidimensional aspects of the end-of-life concerns of terminally ill patients: dying with dignity, dying without pain, reducing the burden on family and caregivers, and achieving a home death, when desired. Traditional emergency medicine training may fail to address hospice as a system of care. When they are unfamiliar with the hospice model, emergency clinicians, patients, and caregivers may find it difficult to properly use and interact with these care services. Potential poor outcomes include the propagation of misleading or inaccurate information about the hospice system and the failure to guide appropriate patient referrals. This article reviews the hospice care service model and benefits offered, who may qualify for hospice care, common emergency presentations in patients under hospice care, and a stepwise approach to initiating a hospice care referral in the emergency department.

An epidemiologic study of closed emergency department malpractice claims in a national database of physician malpractice insurers

OBJECTIVES

The objective was to perform an epidemiologic study of emergency department (ED) medical malpractice claims using data maintained by the Physician Insurers Association of America (PIAA), a trade association whose participating malpractice insurance carriers collectively insure over 60% of practicing physicians in the United States.

METHODS

All closed malpractice claims in the PIAA database between 1985 and 2007, where an event in an ED was alleged to have caused injury to a patient 18 years of age or older, were retrospectively reviewed. Study outcomes were the frequency of claims and average indemnity payments associated with specific errors identified by the malpractice insurer, as well as associated health conditions, primary specialty groups, and injury severity. Indemnity payments include money paid to claimants as a result of settlement or court adjudication, and this financial obligation to compensate a claimant constitutes the insured's financial liability. These payments do not include the expenses associated with resolving a claim, such as attorneys' fees. The study examined claims by adjudicatory outcome, associated financial liability, and expenses of litigation. Adjudicatory outcome refers to the legal disposition of a claim as it makes its way into and through the court system and includes resolution of claims by formal verdict as well as by settlement. The study also investigated how the number of claims, average indemnity payments, paid-to-close ratios (the percentage of closed claims that resolved with a payment to the plaintiff), and litigation expenses have trended over the 23-year study period.

RESULTS

The authors identified 11,529 claims arising from an event originating in an ED, representing over $664 million in total liability over the 23-year study period. Emergency physicians (EPs) were the primary defendants in 19% of ED claims. The largest sources of error, as identified by the individual malpractice insurer, included errors in diagnosis (37%), followed by improper performance of a procedure (17%). In 18% of claims, no error could be identified by the insurer. Acute myocardial infarction (AMI; 5%), fractures (6%), and appendicitis (2%) were the health conditions associated with the highest number of claims. Over two-thirds of claims (70%) closed without payment to the claimant. Most claims that paid out did so through settlement (29%). Only 7% of claims were resolved by verdict, and 85% of those were in favor of the clinician. Over time, the average indemnity payments and expenses of litigation, adjusted for inflation, more than doubled, while both the total number of claims and number of paid claims decreased.

CONCLUSIONS

Emergency physicians were the primary defendants in a relatively small proportion of ED claims. The disease processes associated with the highest numbers of claims included AMI, appendicitis, and fractures. The largest share of overall indemnity was attributed to errors in the diagnostic process. The financial liability of medical malpractice in the ED is substantial, yet the vast majority of claims resolve in favor of the clinician. Efforts to mitigate risk in the ED should include the diverse clinical specialties who work in this complex environment, with attention to those health conditions and potential errors with the highest risk.

[An evaluation of the pediatric medico-legal admissions to a tertiary hospital emergency department]

BACKGROUND

This study aimed to determine the demographic and epidemiological characteristics and to investigate the outcomes of pediatric medico-legal cases who admitted to the emergency department. It was also aimed to contribute to the national survey.

METHODS

Medico-legal charts of the pediatric cases were reviewed retrospectively. Patients were allocated into two groups as traumatic (Group 1) and non-traumatic (Group 2). Age, sex, presenting complaint and frequencies, local or multiple trauma frequencies, and localizations (based on the Abbreviated Injury Scale) and also admission, discharge and mortality rates were ascertained. Data were evaluated by descriptive methods, Kolmogorov-Smirnov and chi-square tests. Values of p<0.05 were accepted as significant.

RESULTS

There were a total of 486 eligible patients. The mean age was 8.91+/-5.08 years (95% confidence interval [CI]). The majority (66.3%) were male. The group aged 5-9 years was larger (33.3%) than the others (in Kolmogorov-Smirnov test, p=0.000). Summer was the most common season for admissions. There were 153 patients in Group 1, and the most common complaint was accidental drug intake (13.8%). In Group 2, the most common reason for admission was motor vehicle accident (32.5%).

CONCLUSION

Motor vehicle and home accidents in childhood are preventable health problems. To ensure a safe environment, continuous health education programs on injury and prevention for parents and children and legal controls will be effective in injury control.