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2 December 2008 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit Past highlights are accessible as well.

1. Hospitalist Interventions May Reduce Emergency Room Crowding

Emergency room crowding is a national crisis. However, emergency room-focused interventions have seen little success. Researchers sought to determine if an active bed management, quality improvement initiative could have a positive effect on emergency room throughput and ambulance diversion. Researchers describe a before and after case study where a hospitalist regularly visited the emergency department, assessed in-patient bed availability, and helped triage admitted patients to particular units. After implementing the program, the average time that admitted patients spent in the emergency department decreased from 458 to 360 minutes. The percentage of hours that the emergency department had to divert ambulances due to crowding and lack of intensive care unit beds decreased by 6 percent and 27 percent respectively.

2. Despite "Apology Laws," Physicians May Not Communicate Medical Errors

One half of the adverse medical events occurring each year in the United Sates are due to preventable medical errors. These adverse events cause up to 98,000 deaths each year. In theory, "apology laws" make it easier for physicians to disclose errors by diminishing their fear that a malpractice suit will follow. In addition, evidence suggests that full disclosure increases patient satisfaction, trust, and the likelihood of a positive emotional experience. A satisfied patient would be less likely to disrupt the physician-patient relationship. Despite the well-recognized benefits of disclosure and apology, most physicians do not communicate their errors to patients. Those opposed to apology laws say that widespread disclosure and apology may "flag" errors, and prompt more claims than are dissuaded by the apologies. The authors argue that regardless of potential drawbacks, apology laws may improve doctor-patient relationships by providing doctors with new opportunities to discuss difficult topics with patients. The authors encourage physicians to talk with their state medical associations and legal counsel about how to best comply with their own states' apology laws.

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. Annals of Internal Medicine attribution is required in stories and articles.

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