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The 2 questions to ask before being discharged from the emergency room

Make sure you're treated as an individual rather than a number

Hospital emergency rooms (ER) are busy places.

Yet, many administrators and bean counters are more interested in metrics than medicine. Under the guise of monitoring productivity, many hospitals and practice groups require emergency physicians to see an unrealistic number of patients per hour. In fact, the metric of patients per hour is a major driver for some physician payment systems.

The problem with this type of setup of measuring a patient per hour doesn’t take into account the complexity or acuity of individual patients. Sure, there are times when a hospital ER is full of patients with minor injuries or conditions. When that happens, it’s easy to see them treat a large number of patients in a relatively short span of time.

But what about those other occasions when there are multiple patients with complex conditions, like traumatic injuries, potential strokes, or heart attacks? Do you think it’s possible for an ER physician to assess and appropriately treat those conditions in just a few minutes? I don’t think so.

In the ever-present effort to see more patients in less time, hospitals have supplemented non-physician emergency room staffing, including nurse practitioners and physician assistants. These members of the healthcare team used to be called mid-level providers, to indicate that they had more training than, for example, a registered nurse but less than a doctor. 

Some states allow nurse practitioners and physician assistants to practice nearly or completely independent of medical supervision by a physician. That’s not the case in Texas, by the way, where their care still requires physician supervision.

We’ve handled numerous cases where patients were inappropriately discharged from the hospital emergency room by a nurse practitioner or physician assistant, when the patient wasn’t even evaluated by a physician. 

That happened to a man in his late 30s whose wife took him to the hospital while he was having stroke symptoms. The entire time he was in the ER, he wasn’t seen by a physician. Instead, a nurse practitioner took his history, did an assessment, and followed them throughout his stay. Tragically, the nurse practitioner ignored his strokes symptoms until it was too late and the man died.

In many other situations, we’ve had clients who felt like they were being pushed out the hospital door even though they had the same symptoms that brought them to the ER in the first place, or even worse. 

For instance, we represented a client who slipped and fell on ice, lacerating her head in the process. Over the course of her emergency room encounter at a northeast Houston hospital, her condition deteriorated to the point that she couldn’t move her arms. Yet, there was an order to discharge her, which the nurses executed even though they had to lift her up and position her in a wheelchair and then physically lift her up and put her in a car to be driven home.

If you’re in a situation where you’re being pressured to leave the hospital or feel like a discharge is being prematurely pushed, here are the 2 questions to ask:

Question 1: Who’s my attending physician and is he or she writing the discharge order? If you haven’t seen your attending physician, ask for an evaluation before you’re discharged. 

Question 2: Can I have a second opinion? Then explain how your condition has improved during your stay. Be careful to describe all of your signs and symptoms, including when they developed.

If you’ve been seriously injured because of poor care in emergency room 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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