Your liability for ED patients

Keypoints:

Admit a patient to the hospital based solely on a verbal report from the ED physician? You may already have. And if you haven't, you may soon.

Most hospitals won't allow ED physicians to admit patients because they want to avoid confusion regarding who will be the patient's attending physician for the inpatient stay. So if an emergency physician calls to inform you that one of your patients is in the ED, what's the best way-from patient care and liability perspectives-for you to respond?

Start by determining whether you have enough information to write orders and develop an initial plan of care without seeing the patient. You may decide that you need to come in and evaluate him before giving any orders. Even if you don't make a trip to the ED, once you take the emergency physician's call, agree to admit the patient, and give orders, you're the patient's primary attending and potentially liable for the care provided.

There are a couple of things you can-and should-do to reduce your liability risk when your patients need emergency care.

First, come to the emergency department and see the patient as soon as possible. Obviously, very sick and unstable patients should be seen immediately.

Second, when you see the patient, write a thorough progress note that includes significant findings that weren't previously relayed to you, or that differ from what you were told. Don't write the note in an accusatory manner because the patient's condition might have changed between the time the ED physician spoke with you and when you saw the patient. But you can certainly document something like: "I was advised by ED physician that at 6 a.m. patient was stable and in no acute distress. When I arrived, patient was hypotensive, diaphoretic, short of breath, and unresponsive. Results of CBC, which were not previously available, now show a significantly elevated WBC with a left shift."

Keeping your own notes may be helpful, but such notes are always subject to a claim that they were prepared after the fact. Moreover, personal records are not "business records" (which are entitled to be admitted into evidence) unless you make them part of the patient's permanent office record. In short, be sure the hospital chart-and the patient's office chart, if you document there as well-accurately reflect (1) the information that you were given, and on which you relied in providing admitting orders, and (2) any inconsistent or additional information you obtained when you saw the patient.

In short, no matter how rushed you may feel, your records should always be thorough. They're likely to be your best defense in a medical malpractice claim.

The author is a health law attorney with Adelman, Sheff & Smith in Annapolis, MD, and Washington, DC. He can be reached by e-mail at aadelman@hospitallaw.com

. This department deals with questions on common professional liability issues. We cannot, however, offer specific legal advice. If you have a general question or a topic you'd like to see covered here, please e-mail it to memalp@advanstar.com. You may also fax your question to us at 201-690-5420, or send it to Malpractice Consult, Medical Economics, 123 Tice Blvd., Woodcliff Lake, NJ 07677-7664.