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Protecting
Yourself From Liability:
The Importance Of Discharge Instructions
As emergency physicians, the riskiest action
we take with patients who present to the emergency department
is to discharge them. Those patients admitted or transferred have
become someone else's problem; those we send home remain our responsibility.
Providing appropriate discharge instructions is the most important
action we can take to protect ourselves from liability and offer
continuing patient care. This is also our only opportunity to
place any risk with the patient; juries respect signed, well-written
discharge instructions. More than 50% of all emergency medicine
lawsuits are related to discharges and many cases are thrown out
when the instructions are appropriate. Discharge instructions
should contain several elements:
- Be time specific - exactly when to follow
up with PCP/specialist or return to ED (especially if not improving
in a set time frame).
- Be action specific - who to see, where
to go, how to care for self (splints, ice, taking meds, etc.),
reasons to return to ED (worsening of condition, CP, SOB, bleeding,
not feeding well, etc.).
- Provide re-entry into system - let patients
know it's ok to return to ED and why to do so, when to activate
EMS.
- Be easy to understand - no "medicalease"
or abbreviations, 4th grade reading level, lay terms, legible.
Patients often do not pay attention or
do not comprehend instructions. It is wise for the physician to
go over these discharge instructions personally with the patient.
When patients ask questions, it means they trust you, so take
that opportunity to solidify the relationship. It is also a good
idea to have family members present for discharge and to document
their presence.
It has been said that the most common piece
of litter outside the Emergency Department is the patient's copy
of discharge instructions. That statement shows how critical it
is to use this tool to protect patients, who are often not interested
in protection, and to protect the hospital and ED staff.
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Contact
us:
3223
8th Street
Metairie, LA 70002
1.504.833.7770
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