Chapter 11.0 IntroductionIn the field of medicine, practitioners work with a lot of uncertainty and explore a variety of grey areas. Decisions made are chosen on the core setting of subjective assessments and conclusions that rely on clinical judgments as opposed to objectively deduced truths. Clinical medical decisions have to be made mostly under short deadlines. Subsequently, the practices in medicine have to be constantly scrutinized under the analysis of experts in the field. The main aim of this scrutiny is to identify the basis behind decisions and the impact of these decisions. Subsequently, medical practitioners can gain an understanding of practices that wok and those that do not, in order to refine the practice. The emergency department is an essential part of any medical facility. Decisions made in the emergency room may salvage or lose the lives of the patients brought in. Often, patients go to the emergency room with problems that require medical attention. It is up to the practitioner to determine which case falls under the description of an emergency and cases that are not emergencies. This paper aims to investigate the understanding of the concept of emergency cases among patients, whether there is a need to carry out education on the concept and to investigate the impact of knowledge on medical screening exams in the Emergency Department on patients.
Objectives of the StudyThe main reasons for carrying out the study will be to:
Find out among patients their understanding of the definition of an emergency.
Establish whether there is a need to educate patients on the concept of an emergency in the clinical setting.
Find out the impact of knowledge of medical screening exams in the Emergency Department on patients.
Background of the Problem of InterestOn April 19 2015, the U.S. Court of Appeals for the Ninth Circuit ruled that in the event a patients emergency medical condition is wrongly diagnosed by a hospital to be a non-emergency, but in spite of this the patient receives adequate medical screening, it is not in contravention of the Emergency Medical Treatment and Active Labor Act. In the case of Robert Jackson, he had been diagnosed with a psychotic disorder and was under medication (West, 2015). Jackson visited the emergency room of a Californian hospital thrice in four days. He later died of a heart attack that was brought about by toxicity to the drugs he was prescribed that caused a psychotic delirium. However, the staff at the hospital did not diagnose a drug toxicity and in the lawsuit they filed, Jacksons family were of the opinon their kin was neglected in application of EMTALA medical screening (West, 2015).
The case was used by the Ninth Circuit to initiate the implementation of a comparative test that was the basis of evaluating compliance with EMTALAs prerequisite that adequate medical screening be availed to all patients in the emergency room, whether or not they could pay (42 U.S. C., Section 1395dd(a) (Bitterman, 2006). For a hospital to be in fulfillment of EMTALA's screening mandate, it should provide any patient with an examination that is similar to any other that would be given to other patients with the same symptoms. EMTALA's screening mandate is a benchmark for consistency in provision of emergency services (Bitterman, 2006).
The case was considerably a major influence in implementing and adopting of triage protocols. Many authors have advocated for the execution of a reasonably calculated triage protocol. The changes over the years in case law are evidence of the shift towards the earlier supposition. The argument is that a comparative test, would be legally enough and effective in observing the law of emergency care by implementing a proper comparable test as dictated by a standard triage protocol.
The case of Robert Jackson raise questions about the concept of emergency care and issues surrounding it. Among the issues surrounding emergency care is the definition of emergency care, the qualification of one for emergency care and the extent to which the caregiver is liable for taking care of emergencies regardless of whether the patient can pay or not. Jacksons family raised the issue in their lawsuit believing their kin was denied adequate and required emergency medical treatment at the hospital. One question that arises from this case is whether Jacksons case was an emergency. Regardless of whether it was an emergency, what criteria is used to evaluate an emergency? Another question raised by the Jackson case is whether there are checks and balances to prevent misdiagnosis of emergency cases as nonemergency and the reverse. While these questions may not evoke clear answers, they are an interesting point of research to note.
Patients have been observed to arrive at emergency departments with symptoms defining them as emergencies. Many a time before EMTALA, patients have been turned down for their cases (Bitterman, 2006). There is need to understand the perception of the term emergency medical condition from the perspective of a prudent layperson. The symptoms that patients display in the emergency department need to be identified and evaluated according to the International Classification of Diseases (ICD-9) standards. Among the most common signs and symptoms that are reported by patients and considered emergencies are gangrene, loss of feeling on a side of the body, coughing blood, paralysis, trouble breathing, seizure, choking, shock and chest pain. Renal colic pain and chest pain are also considered as emergency cases. However, other types of pain are not classified as emergency cases. Symptoms or signs caused by gynecologic problems are not regarded as emergencies (Li, Galvin & Johnson, 2002). Many of the signs and symptoms that are captured in the diagnostic coding manual, ICD-9 do not fall within the scope of the definition of emergency medical conditions by self-appointed prudent laypersons (Li, Galvin & Johnson, 2002). Among the conditions that many prudent laypersons do not consider as emergency medical conditions are many conditions that are usually handled in the emergency department. However, the views of the prudent layperson have not been considered as a basis for determine what is and what is not emergency medical conditions.
The cases indicated above is a portrayal of the perceptions that exist in the medical setting in relation to emergencies. Patients or prudent laypersons have a different view from medical providers on the scope of emergencies. Practitioners carryout a medical screening examination to establish the suitability of a patients condition to qualify as a medical emergency condition. Different health facilities carry out their medical screening examinations according to their set procedures.
Purpose of Medical ScreeningThe main aim of medical screening and medical assessment is to ensure the safety of the patient. In the emergency department, the screening is carried out to determine whether the case falls in the scope of a medical emergency or not. Outside of the emergency department, it prevents a person with a medical condition from being directed away to a facility that does not have the capacity to manage their condition. This minimizes the risk of the persons medical condition going undiagnosed or failing to get adequate treatment and even no treatment at all. Inability or oversight in comprehensively detecting, diagnosing and treating medical conditions has the possibility of increasing morbidity and fatality rates unnecessarily. Additionally, the progress of certain illnesses can be slowed or eliminated entirely by their detection during medical screening. Subsequently, health providers can reduce their liability in the system. Efficiency and promptness in medical screening and assessment are critical aspects in the provision of safety and quality medical care (Stiles, Putnam, James & Wolf, 1979).
1.31 Definition of Medical Screening
The definition of medical screening can be explained as the process of obtaining information about a non-psychiatric medical condition of a person for the examiner to establish the need for more medical assessment or making a decision involving the transfer to another facility for appropriate care. In the field, a licensed physician, certain non-physician clinical staffs, or suitably trained staff are tasked with obtain the information (Stiles et al., 1979)
Medical screening is carried out until the practitioner establishes that the individuals condition is stable. The individual may then be discharged or referred to the care of another healthcare provider. In the course of the procedure, the observations and results have to be clearly documented in the individuals record. The information should then be included in the referral information on case there is a referral for communication to the next provider (Stiles et al., 1979).
Domain of Medical Screening in the Emergency DepartmentComplete medical screening for individuals in the emergency department is comprised of obtaining, developing and merging information form four different perspectives.
History of the individual
A mental status examination
A physical examination according to the case specificity
A laboratory test and other appropriate diagnostic tests as indicated by the clinician.
Medical screening should be done with the multidimensional status of the individual being put under scrutiny as opposed to either the medical or psychiatric dimensions independently. The objective is to establish a general and comprehensive examination of the real clinical situation of an individual. Subsequently, the most appropriate course of action can be established.
Medical Screening versus Medical clearanceThe .terms medical clearance and medical screening are at times wrongly used interchangeably (Epstein, 2007). They are both commonly used by providers in the context of obtaining enough medical information from patients. The...
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