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.

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.

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.