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Emergency room physicians, nurses are responsible for patient care until discharge or admission

Some patients are ignored while waiting for admission or get lost in the shuffle

Hospital emergency rooms (ER) are busy places. Like jugglers, doctors and nurses have to keep a lot of balls in the air. The risk of letting one of those ball drop, though, can mean the difference between life and death or disability for a patient.

One of the hallmarks of professional nursing practice is to advocate for patient safety. Texas Board of Nursing Rule 217.1(5) defines that as one of the fundamental duties that a nurse owes to a patient. In the emergency room setting, this duty applies from the moment a patient arrives until the moment he or she is admitted to the hospital or discharged.

The standard of care requires nurses to assess and accurately and completely report and document a patient’s clinical status, including signs and symptoms, nursing care that’s provided, orders, and the patient's response to treatment.

These standards of nursing practice are defined by Rule 217.11. When caring for a patient, it’s not enough for a nurse to evaluate the patient’s wants. The nursing process involves assessment, treatment, reassessment, and reporting over and over again during the period that a patient’s receiving care.

A middle-aged woman went to a suburban Houston hospital emergency room after falling face first to the ground. The ER triage nurse, bedside nurse, and physician documented her complaints of head and neck pain, as well as the fact that she had no sensation in both legs from the knee down.

Over the course of her four or five-hour ER stay, there was no thorough evaluation or reassessment of the patient’s head and neck symptoms. The ER physician’s discharge note concluded that her lower extremity issue had resolved. Interestingly, the ER nurse documented “MD aware of patient’s weakness before discharge.”

As a former hospital administrator, anytime I see nursing documentation of “MD aware,” it catches my eye. To me, that suggest that the nurse was aware of some sign, symptom, or finding that made him or her uncomfortable.

A responsible, competent nurse would do more than right “MD aware,” and will advocate for further medical reassessment and against discharge until that’s done. Sadly, this patient was discharged home and returned to a separate facility a few days later, where an MRI revealed that she had spinal cord compression in her cervical spine (neck).

With a proper evaluation at the initial ER, there’s no doubt that this could have been surgically decompressed and that the patient would not have developed the permanent neurologic injuries and impairments from which she currently suffers.

The ER doctor and nurse dropped the ball in this case. Perhaps it was a busy night at the hospital. It’s unclear why neither the physician or nurse followed up on the patient’s presenting complaints of head and neck pain, but it’s clear that if they had been focused on patient safety from the start to the conclusion of this patient’s ER encounter, the outcome would’ve been different.

If you’ve been seriously injured because of poor hospital, physician, or nursing care in the emergency room setting in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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