On-site Clinical Risk Comprehensive Assessment:
Emergency Department Services

From a medico-legal perspective, the emergency department (ED) is a high-risk area of the hospital. Lawsuits and claims arising from patient encounters in the ED rank high in frequency and severity are a result of the overburdened state of EDs and the unique environment in which emergency medical care is provided. Missed and delayed diagnoses are leading causes of liability claims in the ED.

Errors relating to conducting patient medical histories and physical examinations, ordering and interpreting tests, ordering consultations, and creating follow-up plans are major contributing factors in missed diagnosis claims studied.
In an effort to meet these challenges, Clinical Risk Solutions, Inc. provides on-site comprehensive risk assessments, a proven methodology to achieve a patient safety-centered model of excellence.

Following a pre-assessment telephonic leadership interview, and completion of a pre-assessment tool, a two –day, on-site assessment is conducted.

A prioritized plan of improvement, resource tool kit, and educational sessions are included within the scope of the initiative.

The ED on-site assessment includes a review of the following areas:

• Completion of a pre-assessment tool and telephonic administrative leadership interview
• Focus interviews with key stakeholders and medical staff leadership
• Culture of safety, communication, team cohesiveness
• Organizational structure, leadership, strategic plan
• Leadership patient safety education session
• Adverse event management process, data analysis, professional liability claims review
• Effectiveness of medical staff leadership, committee structure, documentation, and communication
• Medical staff credentialing, peer review, and physician performance evaluation
• Clinical staffing ratios, nursing credentialing, and competency
• Clinical practices, policies, and procedures
• Triage, screening, examination, treatment, diagnostic, transfer, admission, and discharge
• Quality/patient safety departmental initiatives
• Select policy review—informed consent, procedural sedation, physician order sets, emergency management of psychiatric patients, triage management, transfer, overcrowding plan, medical screening, and delineation of emergency medicine privileges
• ED interface with Diagnostic Imaging, Laboratory, ICU, OB, and OR
• Clinical documentation/assessment tool review
• Structured communication hand off process
• Medication safety management, pharmacy interface and regulatory oversight
• EMTALA compliance review
• Environment of Care standard compliance
• Medical equipment management
• Security management/high-risk patient management
• Infection control/bioterrorism review
• Written comprehensive report with a prioritized plan of improvement
• Tool kit of resource materials