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In a recent malpractice case, the plaintiff alleged that the EP failed to properly treat tetanus in a patient with a dirty puncture wound. “In part, this was because the important historical information was jumbled together confusingly in the hospital’s EMR system,” says Kenneth T. Lumb, JD, an attorney with Corboy & Demetrio in Chicago.
In reviewing EMR documentation, “it’s easy for EPs to miss the forest for the trees,” says Dean Sittig, PhD, professor in the School of Biomedical Informatics at the University of Texas Health Sciences Center in Houston.
Sittig, who authored a paper on the missed Ebola case in Dallas, says, “The ED doc and nurse missed the biggest, most important case of their lives while documenting the appropriate flu vaccination to meet quality measures.”1
Part of the problem was that the EP either overlooked, or couldn’t find, the nursing documentation of the patient’s travel history. “This ‘error of a lifetime’ could have turned into a much more serious problem than it eventually did, with one patient dead and two nurses infected,” Sittig says. “What if the virus would have spread wider?”
Sittig is aware of another ED case in which the EP missed the most recent MRI brain scan report that showed a small bleed. “This happened because the EHR’s default sort order had been changed from most recent first — reverse chronological order — to earliest results first,” Sittig explains.
Since the most recent result was now last on the list, the EP needed to scroll down to view it. “She decided that the report that was visible was the most recent, read it, and decided it was safe to discharge the patient when it obviously was not,” Sittig says.
Although the EHR made the most recent test results difficult to find, it technically was “working as designed,” Sittig notes. “The doctor simply made a mistake. There is really no defense for this error.”
Similarly, EPs sometimes get caught up in clicking “all normal” for a long list of clinical exam findings that they didn’t actually assess. “Many abnormal results are missed due to difficult-to-use EHR screens,” Sittig adds. “But that is not much of an excuse in the eyes of the jury.”
Financial Disclosure: The following individuals disclose that they have no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study: Arthur R. Derse, MD, JD, FACEP (Physician Editor); Stacey Kusterbeck (Author); Jonathan Springston (Editor); Kay Ball, RN, PhD, CNOR, FAAN, (Nurse Planner); and Shelly Morrow Mark (Executive Editor).