Bouncebacks! Emergency Department Cases: ED Returns

Case-based for most effective learning and retention, Bouncebacks helps emergency physicians sharpen their analytical skills to improve patient safety. The illustrative cases educate emergency physicians in documentation, risk management, and evaluation and management of common ED complaints and diagnoses.

Although patients in these cases were not entirely mismanaged, often important "red flags" were missed or ignored. The cases are structured for most learning impact: documentation of initial visits; Greg Henry, MD, FACEP (past president of ACEP) comments on evaluation and documentation from medical and risk management perspectives; final ED visits, diagnosis and hospital/surgical courses; and national experts' referenced discussions of appropriate ED approaches to diagnosis and management.

Goals include patient safety, continuing education in documentation, risk management, and discussion on evaluation and management of common ED complaints and diagnoses.

Bounce Backs! Emergency department cases: ED returns is an emergency department case study book by Michael B.Weinstock, MD and Ryan Longstreth, MD, with case by case commentary by Greg Henry.

The book's primary goal is to improve patient safety. Although these patients were not entirely mismanaged, often important "red flags" were missed or ignored. Additional goals include continuing education in documentation, risk management, and discussion on evaluation and management of common ED complaints and diagnoses.

Thirty cases of patients are presented who "bounced back" to the ED; some arrested shortly after returning to the ED and some were again discharged (one patient had 6 ED visits). The patients presented with common problems such as headache, fever, abdominal pain, back pain, and chest pain; complaints which could have occurred in any ED, urgent care or primary care physician's office.

The layout of the book is straightforward. Each chapter begins with documentation of the initial patient visit(s) with the actual physician documentation (with typos, strange abbreviations, etc.), with only minimal modifications to ensure anonymity and readability. Next, Greg Henry comments on the physician's evaluation and documentation from both a medical and risk management perspective. He makes his comments while "blinded" to the eventual ED diagnosis. He does this for all 30 cases. We then present the final ED visit, diagnosis, and hospital/surgical course.

Finally, there is a referenced discussion of the appropriate ED approach to patients with this presenting complaint and eventual diagnosis by ED leaders including Jeffrey Kline, Steve Colucciello, Andy Jagoda, Amal Mattu, Lance Brown, Ann Dietrich, Sharon Mace, Wyatt Decker, Doug Rund, Raymond Jackson, Robert Dart, Billy Mallon, Stephen Karas, Scott Melanson, Tom Lukens, Sandy Craig, Wesley Eilbert, and Jud Hollander. These discussions refer to specific aspects of the evaluation and management of the case presented.

We close with a tongue-in-cheek discussion of medical malpractice issues, entitled; "So you want to be sued for malpractice; the top-ten ways to maximize your risk."