Emergency Department Liability

EDs are challenging and complex high-acuity, high-demand clinical environments in which physicians make rapid decisions often based on incomplete or imperfect information (Brown et al.). Patients are cared for by physicians with whom they typically have no ongoing relationship, in a care setting with perpetual shift changes and handoffs and requiring completion of numerous operational steps under time constraints that may be made worse by crowding (Kachalia et al.; Brown et al.).

Much is demanded of hospital EDs and ED practitioners. They treat not only adults and children suffering traumatic injuries, but also individuals experiencing acute life-threatening conditions such as stroke, myocardial infarction, and thoracic aortic dissection, and patients experiencing acute exacerbations of chronic illnesses, drug and alcohol abuse, acute manifestations of previously undiagnosed illnesses, psychiatric conditions, obstetric problems, poisoning, medication overdoses, toxic effects of chemicals, burns, and adverse effects of medical treatment. Patients affected by these and other ailments, including nonurgent medical conditions, arrive at the nation's EDs around the clock on a daily basis. In addition to responding to such daily occurrences, hospital EDs must be prepared to handle patients injured in mass casualties and other disasters.

The Centers for Disease Control and Prevention (CDC) estimated the characteristics of hospital ED use in the United States in 2011, the last year for which data are available, as follows (CDC "Emergency Department Visits"):

Geriatric and pediatric patients are the greatest users of ED services. In 2009–2010, 19.6 million ED visits were made by people age 65 or older. The visit rate for this patient population increased with age, as did the percentage of ED visits made by nursing home residents, patients arriving by ambulance, and patients admitted from the ED to the hospital. Patients age 75 or older had the highest rate of ED visits for ischemic stroke or transient ischemic attack between 2001 and 2011 (CDC "Trends").

In 2012, 18% of children aged 0 to 17 years with Medicaid coverage were seen in the ED at least once (CDC "Reasons"). Regardless of patients' insurance status, most pediatric visits to the ED occurred at night and...