Consultation for Simple Laceration Repair When On-Call in the Emergency Department: Potential Quagmire.

What are the forces obligating a plastic surgeon who is on-call for the emergency department to respond to a consultation request for repair of a simple laceration? Although the duties are clear in cases of obvious surgical emergency, ambiguity and subsequent conflict may arise when the true nature of the emergency is less clear. Does the consultant's clinical discretion dictate the obligation in the case of a simple laceration; or is it subservient to either the discretion of the requesting health-care provider or even the patient? Do federal statutes such as the Emergency Medical Treatment and Labor Act, or perhaps more local rules apply, such as the by-laws of the hospital? It would behoove all medical practitioners to familiarize themselves with both the legal and moral implications of these issues. Having legitimate policies in place which actively address those situations where the consultative obligation is unclear is critical to resolve potential conflict.

Documentation proficiency of patients who leave the emergency department against medical advice.

Study Objective: This study describes the current documentation practices of health-care providers in the emergency department (ED) during the discharge against medical advice (AMA) process.

Methods: This retrospective cohort study reviewed health care provider documentation of adult patients who left an ED AMA in one year. Each encounter documentation was reviewed for eight medicolegal standards including the documentation of 1) the patient's capacity; 2) the signs and symptoms; 3) the extent and limitation of the evaluation; 4) the current treatment plan, risks, and benefits; 5) the risks and benefits of forgoing treatment; 6) the alternatives to suggested treatment; 7) the explicit statement made by the patient who left AMA, as well as the explicit documentation of what the patient was refusing; and 8) the follow-up care including discharge instructions.

A survey of policies and procedures on the communication and documentation of radiologic interpretations.

Research into emergency medicine (EM) diagnostic errors identified imaging as a contributing factor in 94% of cases. Discrepancies between the preliminary (trainee) and the final (attending) diagnostic imaging interpretation represent a system issue that is particularly prone to creating diagnostic errors. Understanding the types of systematic communication and documentation strategies developed by academic radiology departments to address differences between preliminary and final radiology interpretations to clinicians are threshold steps toward minimizing this risk.

Communication and documentation of preliminary and final radiology reports.

The "wet-read" consultation has been defined as a rapid response to a clinical question posed by a physician to a radiologist. These preliminary interpretations are often not well documented, have poor fidelity, and are subject to modifications and revisions. Moreover, preliminary interpretations may be subject to reinterpretation through a variety of scenarios.

Leaving against medical advice: facing the issue in the emergency department.

Patients leaving the emergency department (ED) against medical advice (AMA) represent 0.1% to 2.7% of all ED patients.

Informed consent for research: current practices in academic emergency medicine.

Background: The emergency department (ED) environment presents unique barriers to the process of obtaining informed consent for research.

Objectives: The objective was to identify commonalities and differences in informed consent practices for research employed in academic EDs.

Methods: Between July 1, 2006, and June 30, 2007, an online survey was sent to the research directors of 142 academic emergency medicine (EM) residency training programs identified through the Accreditation Council for Graduate Medical Education (ACGME).

Torts to contract? Moving from informed consent to shared decision-making.

Many claims of medical malpractice arise from a breakdown in communication between physician and patient. As a result, medical decision-making may change from an informed consent model to a shared decision-making strategy. Shared decision-making, a contract derivative, will trigger contract obligations and change the face of medical malpractice from tort to contract.

Knowledge translation at the macro level: legal and ethical considerations.

Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians.

Diagnostic CT scans: institutional informed consent guidelines and practices at academic medical centers.

Objective: The purpose of this article is to characterize current informed consent practices for diagnostic CT scans at U.S. academic medical centers.

Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks.

Purpose: To determine the awareness level concerning radiation dose and possible risks associated with computed tomographic (CT) scans among patients, emergency department (ED) physicians, and radiologists.

Materials And Methods: Adult patients seen in the ED of a U.S.