Emergency Medicine

DESIRABLE HABITS OF THE GOOD EMERGENCY DEPARTMENT DOCTOR

Administrative and Legal Issues 449

11 Finally, appreciate the stress and anxiety caused to yourself and the nursing
team following an unsuccessf ul or critica l resuscitation.
(i) Try to meet together briefly to talk over events and express your
own feelings and emotions, rather than simply debriefing the
medical aspects of the care.
(ii) Thank everyone for their efforts, particularly the nurse who dealt
with the relatives and the nurses who were left to lay out the body
in the case of sudden death.

Risk management and incident reporting

The five mainstays of effective risk management include credentialling of medical
staff, incident monitoring and tracking, complaints monitoring and tracking,
infection control, and documentation in the medical record.
Whether any or all of these activities are adopted at your hospital, you can begin
by empowering yourself.

1 Recognize the types of ED situations that lead to incidents and claims, or to
an ED doctor requiring medicolegal assistance from a medical defence
organization (MDO). These include:
(i) Failure to correctly diagnose the patient’s medical condition.
(ii) Delay in diagnosis.
(iii) Failure to treat the patient.
(iv) Dissatisfaction with treatment.
(v) Dissatisfaction with the medical practitioner’s conduct.
(vi) Medicolegal assistance:
(a) regarding death of a patient
(b) for a medical report regarding diagnosis and treatment.

2 Some of the more common reasons ED presentations are reported as
incidents to an MDO are for the following failures:
(i) Failure to diagnose
(a) myocardial infarction
(b) cerebral haemorrhage, particularly subarachnoid
(c) appendicitis
(d) torsion of the testis
(e) fractures, e.g. scaphoid, phalanx, neck of femur, talus,
calcaneus, etc.
(ii) Failure to diagnose or treat appropriately
(a) tendon/nerve injury, particularly lacerations to the hand or
foot
(b) wounds/wound infections, particularly inadequate
debridement and cleaning
(c) foreign body, including glass and intraocular
(d) spinal fracture.
(iii) Medication error