Case 7: Return ED Visit
The patient continued to feel poorly at home. He called into the ED 2 days later, discussed his symptoms, and was told to take ibuprofen. This phone call was not documented and it is unclear to whom he spoke. 3 days after his discharge, he returned to the ED. The entire record is shown below: […]
Case 7: Billing
Dr. Jason Adler (@ercoderguy), an Emergency Medicine physician and expert on EM coding and billing, has kindly offered to provide a review of this information. The billing information for this visit is shown here, and Dr. Adler’s explanation is below. This certainly meets documentation guidelines for a level 5 (99285) visit. There is a comprehensive […]
Case 7: Disposition
Given the lack of emergency results on the tests, the physician elected to discharge the patient. Repeat vitals were measured and are shown below. For easy comparison, triage vitals are shown on the left and discharge vitals shown on the right. The doctor’s medical decision-making is shown here: Here are the discharge instructions: Nursing discharge […]
Case 7: Testing and Treatment
The physician ordered the following tests and started treating the patient: The physician also later added on a leptospira antibody. The results of testing are displayed below: Given this information, what would you do next? Is any further testing or treatment indicated? Should this patient be admitted or discharged? Continue to the next page to […]
Case 7: Ankle Injury
This case concerns a young man with a seemingly benign injury, exotic travel history and a challenging diagnosis. The patient is a 30 year old man who checks into the ED with ankle pain. He had gone to an outpatient clinic, but was referred to the ED. The triage information including initial vitals are show […]
Case 6: Documentation Review
The documentation review this month is slightly different than previous months, because the patient was not discharged prior to the bad outcome. The bad outcome was apparent prior to her departure from the ED. Also, the physician who was sued never wrote a note about the patient (nor should he have written a note). I […]
Case 6: Medical Review
Airway management is one of the most popular topics of discussion among ER doctors. This case will certainly spark debate and strong opinions from many readers. There were multiple factors that all contributed to this patient’s death. The purpose of this review is not to use hindsight to harshly judge the clinician, but to find […]
Case 6: Legal Outcome
The case did not go to a jury trial. Dr H’s attorneys filed a motion for summary judgment, which was granted. The lawsuit against the doctor was dismissed. The doctor’s hospital had also been named in the lawsuit, and it was dismissed at this time as well.
Case 6: Depositions
Dr. H was deposed as part of the case. The excerpts from the deposition are shown below, with the plaintiff’s attorney asking questions of Dr. H. The attorney next asked Dr. H about his understanding of the patient’s airway status. Dr H was asked more questions about the transfer and his preparation for the deposition. […]
Case 6: Lawsuit
The patient’s family members reviewed her case with a law firm, and a lawsuit was filed. The physician who was sued was the ED doctor from the regional medical center where the patient was transferred. Recall that this physician (Dr H), spoke with the sending doctor via phone, and recommended that the patient be transferred […]