Medico-legal risk and use of medical directives in the emergency department.

Autor: Cortel-LeBlanc MA; Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada. mcortelleblanc@gmail.com.; Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. mcortelleblanc@gmail.com., Lemay K; Canadian Medical Protective Association, Ottawa, ON, Canada., Woods S; Canadian Medical Protective Association, Ottawa, ON, Canada., Bakewell F; Department of Emergency Medicine, QEII Health Sciences Centre, Halifax, NS, Canada.; Faculty of Medicine, Dalhousie University, Halifax, NS, Canada., Liu R; Canadian Medical Protective Association, Ottawa, ON, Canada., Garber G; Canadian Medical Protective Association, Ottawa, ON, Canada.; Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, Canada.
Jazyk: angličtina
Zdroj: CJEM [CJEM] 2023 Jul; Vol. 25 (7), pp. 589-597. Date of Electronic Publication: 2023 May 12.
DOI: 10.1007/s43678-023-00522-1
Abstrakt: Purpose: The medico-legal risk associated with application of medical directives in the emergency department (ED) is unknown. The objective of this study was to describe and analyze factors associated with medico-legal risk in cases involving medical directives in the ED.
Methods: We conducted a descriptive analysis of closed medico-legal cases [hospital complaints, regulatory authority (i.e., College) complaints, and civil legal actions] involving emergency physicians in Canadian EDs involving medical directives (alternate terms including "standing order", "nursing initiated", "nurse initiated", "nursing order", "triage initiated", "triage ordered", "directive", "ED protocol", and "ED's protocol"). We used data from closed cases involving the Canadian Medical Protective Association from January 2016 until December 2021. We abstracted descriptive factors of the cases and used a framework for contributing factors classification.
Results: From 2016 until 2021, 43,332 cases were closed and 1957 involved emergency physicians for which there was medico-legal information available for analysis. In all, 28 involved emergency physicians and medical directives. Situational awareness, team communication, and issues with clinical decision-making were the most important factors contributing to harm and medico-legal risk. Peer experts were critical of physicians not reviewing all results available for patients when initiated through a directive, misinterpreting test results, a less than thorough initial assessment, and of failing to reassess patients or re-order investigations when indicated.
Conclusion: Our findings suggest that the medico-legal risk exposure from the use of medical directives in the ED is low. Emergency departments may consider implementing systems to support adherence to medical directive policies, ensure physicians are alerted when medical directives are completed in a timely fashion, and leverage tools to notify the healthcare team when results have not been reviewed.
(© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
Databáze: MEDLINE
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