Published in the November 2005 issue of Today’s Hospitalist
At the Atlanta meeting of the Fall 2005 Hospitalist CME Series,
one of the speakers explained that patients with an ST-elevation
myocardial infarction should go to the cath lab for percutaneous
coronary intervention within 90 minutes. The evidence has shown that
the faster these patients receive PCI, the better they fare.
That’s when a physician in the audience asked a question that no
study has addressed: What happens when the emergency department
calls a hospitalist, not cardiology, and the patient is delayed in getting
to the cath lab?
In the ED, after all, 90 minutes can pass in the blink of the eye. If the
patient experiences problems because of that delay, will the hospitalist
be on the hook legally?
The scenario isn’t so difficult to imagine: A malpractice attorney grills
the hospitalist about why she didn’t call cardiology or send the patient
to the cath lab right away.
The latest guidelines, after all, call for cardiac catheterization
for exactly this type of patient as soon as possible. Shouldn’t the
hospitalist have known to act more quickly or hand the patient off to a
As hospitalists branch out and expand their role in the hospital,
some worry that they may be increasing their liability risk. Emergency
departments are triaging an ever growing number “and a wider
variety “of patients to hospitalists.
The question is whether that trend will pit hospitalists against the
litigious nature of our society and our health care system.
Editor and Publisher