September 2014 - In This Issue

Upcoming Events

We are attending and/or exhibiting at the following conferences. We hope to see you there!

• UCAOA National Urgent Care Convention: Oct 9-11 in Denver, CO
• ACEP Scientific Assembly: Oct 27-30 in Chicago, IL
• ASHRM Annual Conference & Exhibition: Oct 26-29 in Anaheim, CA
• Cayman Captive Forum: Dec 2-4 in Grand Cayman

 

New Courses

• Workplace Violence in the Healthcare Setting
• Information Security Tips for Healthcare Professionals
• Pediatric Seconds-to-Minutes Emergencies, Part 2
• Documentation Guidelines: Requirements for Reimbursement
• Ultrasound at the Bedside in the Emergency Department
• Placental Pathology Part 2

TSG is honored to welcome John West to the RSQ Collaborative!

John is working with TSG to develop a suite of courses highlighting medical-legal issues for physicians, nurses and allied health professionals. We are putting the finishing touches on the first course focused on legal pitfalls in surgical practice. In the meantime, please enjoy the following case analysis.

 

Psychiatric Boarding

 

The involuntary treatment act (ITA) in the state of Washington allows for the involuntary commitment of persons who are a danger to themselves or others, or who are gravely disabled, as a result of a mental disorder. These persons are to be committed to a certified evaluation and treatment facility for care. The ITA allows for treatment outside a certified facility if the patient's medical needs require such care. However, the Washington Department of Social and Health Services (DSHS) regularly filed for a single bed certification that allowed DSHS to place involuntary patients in an emergency department (ED) or elsewhere in an acute care facility, even though these were not certified facilities. Such single bed certifications were normally sought because there were no available beds in certified facilities.

 

Ten patients who were held on single bed certifications filed for review with the Washington Mental Health Commissioner, who held that such placements were unlawful unless the placement was to meet a medical need that a certified center could not meet. The trial court affirmed this holding, albeit on different grounds. The court of appeals consolidated the cases and transferred the matter to the Supreme Court of Washington.

 

Although DSHS argued that the court should not overrule the professional judgment of the mental health professionals, the court held that that was not the issue. The court noted that this was not a case involving a patient who was placed in a single bed certification due to medical needs that a certified facility could not meet. Rather, this was simply a case of such placement due to overcrowding in certified facilities. The court ruled that this situation was not covered by the ITA and affirmed that it was unlawful.

 

The use of EDs, acute med/surg floors or ICUs for psychiatric boarding is a widespread and pernicious problem for hospitals. This case does not rule that such a practice is per se unlawful, only that the Washington DSHS mechanism for enforcing the ITA is unlawful. EDs in Washington may still have to hold behavioral patients if they present to the ED for the first line of treatment. This case only affects those patients who are placed there by DSHS.

 

It is unlikely that this decision will immediately end this practice in Washington. More beds and facilities will have to be certified and/or developed, but that will be a step in the right direction. It is probably the case that every state in the Union needs more psychiatric beds. Perhaps this case will spur their development.

 

In the matter of the detention of D.W. v. DSHS, No. 90110-4 (Wash. August 7, 2014)

 

Featured Courses:

• Medical Legal Concerns in Surgery - Coming Soon!

Follow John 

Follow this topic: RSQ_Education 

The CORE Program

 

TSG worked with several members of the RSQ® Collaborative over the last year to develop a Comprehensive Online Risk Education (CORE) Program. The RSQ® Solutions - CORE Program provides risk managers with a scalable solution for ensuring all of their clinicians receive education and training on important risk and safety issues. Furthermore, recent additions to the CORE Program library include topics that support the healthcare industry's migration towards clinical integration and care coordination. 

 

The program is structured to provide all staff with risk and safety fundamentals and is then customizable based on your facility's specialty-specific requirements. Many of the courses I've worked with TSG to develop over the last few years are now a part of that program.

 

Please visit us at ASHRM, Booth 507, to learn more about this program.

 

Featured Courses:

• Handoffs, Transitions & Discharges: Key Moments in Patient Care
• 7 Strategies to Reduce Hospital Readmissions
• Communication Strategies to Improve Patient Safety in High-Risk Situations
• 11 Simple Strategies to Prevent Medication Errors
• Technology Revolution: Improving Patient Safety, Reducing Liability
• Essentials of Patient Safety
• Prevention of Medical Errors 

Follow Arnie 

Website: www.drmackles.com

Follow this topic: RSQ_Education 

Surgeon Admits Error; Insurer's Attorneys Balk
Caroline Carcerano went to Tufts Medical Center last November (2013) for what she hoped would be a brief procedure to relieve back pain. She died instead. The surgical team inserted a dye into her spine that is not supposed to be injected in the spine, and Caroline died the following day. Read more

 

The Sullivan Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Some continuing education activities were approved by the Emergency Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

The details of the CME and/or CE for all TSG activities can be found here.