Policy and procedure

Question 1

Behavioral restraint reassessment requirements, adults, kids 9-17, < 9

data range, 1, 2, 3 standard deviations

diagnostic versus treatment error, review

Answer 1

Adults 4 hours, kids 2 hours, < 9, 1 our

1 - central 68%, 2 - 95%, 3 - 99%

–Diagnostic errors (most common cause of litigation)

• Error or delay in diagnosis
• Failure to employ indicated tests
• Use of outmoded tests or therapy
• Failure to act on results of monitoring or testing
• Overdiagnosis (CT angiogram for low-risk chest pain)

–Treatment errors

• Error in performance of a procedure (“time out”)
• Error in administering treatment (distraction, name checks)
• Error in the dose or method of using a drug
• Avoidable delays in treatment or responding to abn. tests.
• Overtreatment (antibiotics for bronchitis)

Question 2

Preventative error
communication error

ASA classes

Answer 2

Preventive errors

• Failure to provide prophylactic treatment (hand washing)
• Inadequate monitoring or follow-up

Communication error - “pass-ons,”aftercare instructions, translators

• ASA I A normally healthy patient
• ASA II A patient with mild systemic disease
• ASA III A patient with severe systemic

disease and functional limitations

•ASA IV A patient with severe systemic

disease that is a constant threat to life

•ASA V A moribund patient who is not
expected to survive without the
procedure

Question 3

First problem in a disaster
most common problem in disaster

What is National disaster medical system (NDMS)

Answer 3

First-communication
most common-lack of backup resources

NDMS

–Section of the Department of Homeland Security

–Supplemental medical response in case of catastrophic disaster

–DMATs (disaster medical assistance teams): federally paid medical volunteers and support staff responding to the NDMS

Question 4

Standard triage tags

EMTALA highlights

MSE

definition of hospital campus

Answer 4

–BLACK = morgue –RED = life-threatening injury –YELLOW = serious but stable –GREEN = nonserious, minor

MSE required in any emergency condition stabilized regardless of ability to pay
campus includes 250 yards surrounding hospital buildings

Question 5

EMTALA and minors, federal versus state law

who can do an MSE

on call physician requirements

active labor is by definition

Answer 5

Federal trumps state law

anyone qualified as determined by hospital bylaws

on call must come to the hospital and reasonable amount time

by definition unstable

Question 6

EMTALA transfer - who determines mode of transportation?

Fine for violations?

Automatic emancipated minor status

Answer 6

Transferring facility

$50,000

married/pregnant, active duty, living away from home, self-supporting, STDs, mental health and substance abuse in some states

Question 7

Advanced directives/DPOA become active when

infectious disease, non-obvious mandatory reporting for

malpractice, most common claims categories (2)

Answer 7

when one or two physicians certify patient lacks medical decision-making capacity

for hepatitis

claims: missed fracture/dislocation; wound care including infection, tendon injuries, neurovascular injuries and missed foreign body

Question 8

Requirements to win medical malpractice suit (4)

professional versus contributory/comparative negligence

Answer 8

Duty to treat
standard of care
proximate cause
damages

professional is on the part of the provider
contributory is on the part of the patient