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Malpractice Reform’s Effect on ED Care

Malpractice Reform’s Effect on ED Care

It is often claimed that “defensive medicine” is a major source of wasteful medical spending. One report estimated that $210 billion is spent each year on needless care that is motivated by fear of lawsuits. Despite this widespread belief, few previous studies have directly measured the effect of malpractice reform laws on clinical practice. Emergency care may be at particular risk for accruing high costs from defensive medicine practices. “Emergency physicians operate in an information-poor, high-risk environment that would seem to be as prone to defensive practice as any other,” says Daniel A. Waxman, MD, PhD. Most changes to tort law have focused on limiting the size of awards, such as putting a cap on noneconomic damages. ED care, however, has been a focus of a new kind of reform that might be expected to offer a stronger sense of protection to emergency physicians. About 10 years ago, Texas, Georgia, and South Carolina changed their malpractice standard for emergency care from the usual “deviation from the standard of customary practice” to “willful and wanton negligence” (in Texas) and “gross negligence” (in Georgia and South Carolina). Those two standards are essentially synonymous. The three states’ laws, which also have other provisions that apply outside the ED, are summarized in Table 1. “The gross negligence standard is widely acknowledged to be an incredibly high bar for plaintiffs to meet, and the laws therefore offer very strong protection to emergency physicians,” Dr. Waxman says. “For example, plaintiffs must prove ‘conscious indifference,’ meaning that a physician knew that an action would probably cause serious injury and then took the action anyway.” New Research...
ATS 2015

ATS 2015

New research was presented at ATS 2015, the American Thoracic Society’s annual meeting, from May 15 to 20 in Denver. The features below highlight some of the studies that emerged from the conference. Predicting COPD Exacerbation Readmissions The Particulars: Previous studies have found that the 30-day readmission rate following an acute exacerbation of COPD (AECOPD) can be as high as 23%. However, predictors of readmission after AECOPD have not been well established in clinical investigations. Data Breakdown: For a study, researchers used uni­variate analysis to identify predictors of 30-day readmission among patients hospitalized with a primary diagnosis of AECOPD. The authors found that low forced ejection fraction in 1 second (FEV1) and a history of depression independently predicted 30-day readmission. Take Home Pearl: Depression and low FEV1 appear to predict 30-day readmission following hospitalizations for AECOPD. E-Cigarette Use in Older Adults The Particulars: Elec­tronic cigarettes (e-cigar­ettes) are increasingly being used by smokers. However, data are lacking on the use of e-cigarettes in older Americans, those with smoking-related lung disease, or ethnic minorities. Data Breakdown: Researchers assessed e-cigarette use among more than 10,000 Caucasian and African-American current and former smokers with at least 10-pack years. Those who had tried e-cigarettes were significantly more likely to be current smokers, compared with those who had not. About 91% of e-cigarette users reported using them to cut down on tobacco cigarette use, but only 47% did so. COPD exacerbation and chronic bronchitis rates were similar among e-cigarette users and non-users. Take Home Pearl: E-cigarette use does not appear to reduce tobacco cigarette use or alter the progression of COPD. Detecting Lung Changes During...

Operating on One of Our Own

Even though Phoenix is a big city (sixth largest in the U.S.) the surgical community is a relatively small. We all know most of the other general surgeons in the Valley, if not personally, then by reputation or at one degree of separation. We know who is the best at a particular procedure, who responds quickly to calls, who you can trust in a pinch and who you can’t. One gets closer to surgeons who are in the same immediate circle as you; the ones you see week in and week out in the locker room or the doctors lounge or waiting in the OR to start their own cases. Many of them you may have worked with directly on the same team, especially in trauma. Others you know only by sight and name, but they are still definitely part of the surgical ‘family.’ Wider associations are formed with the nurses who work in your operating room or in the trauma rooms; with the technicians who draw the labs and manage the ventilators, and scrub your cases; with the representatives from the equipment companies and the surgical device manufacturers who seem to be a ubiquitous as scrub techs. They all are included in the wide circle of those whom you know and regard as part of your world. “Surgeons who are in the same immediate circle as you…you know only by sight and name, but they are still part of the surgical ‘family.’”   When you work trauma long enough, it’s inevitable that someone you know will appear in your trauma unit. The rules for family members are clear:...
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