In cases that involve medical records, an attorney’s understanding of the treatment setting(s) is key. This is particularly true when dissecting records from an emergency department (ED). Though it may be physically connected to the hospital facility, the emergency department is an entirely separate entity. The state and federal laws that govern emergency departments, and the procedures and operations utilized there, are unlike other units within the hospital.
Tip # 1
When examining a case involving the emergency department, you must obtain all the records from the emergency department. This sounds obvious, but may prove challenging. Often attorneys obtain an “abstract” of medical records, which is understandable when first trying to evaluate a case. Unfortunately, an abstract will likely give you an inaccurate understanding of the care a patient received. Nurses’ notes are highly valuable to provide a complete picture of the occurrence―from what happened with the patient to what the physician or mid-level did (or did not do). Don’t take shortcuts when obtaining these records; even if the issue is not nursing related, their notes will reveal more than you anticipate.
Tip # 2
When obtaining ED records, know what you need. There are separate areas of the emergency department, and each will have its own documentation. For example, the physical location of triage is usually a separate area of the department, and it will be staffed by a medical provider (usually an RN). This is typically the entrance point for patients, unless they arrive via ambulance. This initial contact with the patient will have its own documentation. After triage, a patient will be seen by the “primary nurse” in a separate area. This new area will also entail separate documentation. Whether the facility is still documenting on paper or has upgraded to electronic records, there will still be separate documentation from each station and provider.
Tip # 3
Ensure that a medical expert who is well-versed in emergency department evaluations reviews your records to determine issues with standards of care. To reiterate, the ED is a distinct area of the hospital, and there are certain standards of care that not every medical provider or attorney is aware of. For example, I was asked to look at a case that primarily involved the physician and mid-level provider in the emergency department. When I initially reviewed the emergency department records, I noticed huge breaches in standard of care from the nurses. Unfortunately, it was too late to bring the nurses into the suit, and by extension the hospital, who would have been implicated as the ostensible agent. An earlier review by an expert consultant would have changed the face and outcome of the case.
Medical cases that involve emergency departments carry an increased level of complexity. In order to deliver top-level representation to your client, take the necessary step of consulting with a medical expert from the beginning.