Ambulatory Care Quarterly

Wait time too long? Reduce risks this way

To reduce legal risks, the best strategy is to "show diligence," says Linda M. Stimmel, JD, a partner with the Dallas-based law firm of Stewart Stimmel.

Document your ED's efforts to provide adequate staffing, and educate staff and physicians on improved triage techniques, such as attendance logs on inservices to improve triage.

Here are other risk-reducing practices:

• Address concerns of a patient or family member by providing an immediate reassessment.

Emory Petrack, MD, FAAP, FACEP, a medical-legal consultant and principle of Shaker Heights, OH-based Petrack Consulting, says, "When someone comes to a staff member, whether a physician, nurse, clerk or anybody, and expresses concern about their loved one, do not blow that off."

• Post signage and verbally inform patients to let the nurse know if their condition worsens.

"On some level, you are putting that responsibility on the patient," says Petrack. "I think it's fine to let people know that it's a busy ED, and you need to work with us to make sure you are taken care of."

• Keep patients informed continuously. Jonathan D. Lawrence, MD, JD, FACEP, an ED physician and medical staff risk management liaison at St. Mary Medical Center in Long Beach, CA, says, "From a consumer standpoint, people often don't mind waiting, as long as they know what they're waiting for. But when it's busy, usually the triage nurse doesn't have time to go out there and make nice. And those are exactly those times that are most tension-filled."

Instead, an administrator might tell patients that an ambulance just brought in additional patients from a motor vehicle crash, and the ED staff are doing the best they can but an exact wait time can't be given.