Risk Management for Emergency Medicine Physicians

In emergency medicine, every second counts and clear communication can make the difference between positive and negative patient outcomes. This page outlines essential strategies for gathering accurate patient information and maintaining effective communication in the emergency department (ED), where providers often must make critical decisions with limited background knowledge.

In addition, the critical areas of documentation and follow-up are discussed. We’ll also explore proven techniques for patient interaction, history taking, and interdepartmental communication that can help ED providers deliver optimal care while managing risk.

Patient interaction

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When a patient comes to the ED, physicians often do not have complete information regarding the patient’s history, medications, and social activity. Additionally, patients may be poor historians of their own health history and medications. Here are some ways to establish rapport and help solicit information from ED patients.

Initial patient contact

• Quickly establish your role and name
• Acknowledge the stress/pain/discomfort they're experiencing
• Use phrases like “I know we're meeting for the first time, but I'm going to do my best to help you.”
• Set clear expectations about the ED process and potential wait times
• Ask about immediate concerns first before diving into full history
• Include family members/support people in the conversation when present
• Review the patient’s intake form and confirm information.

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Medical history

• Start with the most critical history elements for their presenting symptom
• Document attempts to obtain outside records
• Show you’ve reviewed available information: “I see you were here last month for...”
• Note when history is limited or unclear due to patient condition
• Ask about allergies, current medications, and recent health care visits early
• Document all sources of history (patient, family, EMS, outside records)
• Clearly record if patient is unable to provide history

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Patient communication

• Narrate what you’re doing during examinations.
• Explain your diagnostic reasoning briefly but clearly.
• Give time estimates when possible: “I’ll be back in about an hour with your results.”
• Explain delays honestly: “Several critical cases came in, but you haven't been forgotten.”
• Use inclusive language: “We're going to figure this out together.”
• Acknowledge their expertise about their own body/condition.

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At discharge

• Create clear, written discharge instructions in simple language.
• Include specific symptoms that should prompt return to ED.
• Use teach-back method for critical instructions .
• List recommended timeline for follow-up care.
• Give written and oral instructions for obtaining test results.
• Explain what findings would require earlier follow-up.
• Provide specific names/numbers for follow-up providers.

Caregiver communication

Communication among members of the health care team is another important aspect of patient care in the ED. A breakdown in communication between providers can result in adverse outcomes. Communication between providers is especially critical during shift changes.

Effective communication between providers can be facilitated through policies that determine when and how to notify other providers regarding patient care. Within these policies, documentation should be required, so that the chart will accurately reflect what took place.

Here are targeted risk management strategies for improving communication among caregivers in the ED.

• Have clear handoff protocols for shift changes.
• Record all communication with consultants.
• Note response times for critical services.
• Document detailed handoff for complex cases.
• Establish relationships with key follow-up providers/clinics.
• Create protocols for handling patients without primary care.

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Documentation best practices

Thorough documentation can be a physician’s best defense. Emergency care may present significant challenges to good documentation due to urgency and the potential distraction of managing multiple patients. Below are a few documentation areas that may become critical in the event of a poor patient outcome:

• Document your review of history, triage and nursing notes.
• Review home medications at admission, and again at discharge for accuracy.
• Document timing of patient re-evaluations.
• Document any significant changes in patient condition.
• If using scribes, review notes prior to signing off.

Discharge

While it may feel like once a patient leaves the emergency department your job is done, protocols for managing patients both during and after their visit to the emergency department are critical. Once the patient leaves the emergency department, it may be challenging to follow up on any pending results or needed referrals. Tracking protocols and assistance from designated staff can help. These follow-up and documentation elements are recommended:

• Note any barriers to follow-up identified during discharge planning.
• Create direct communication channels with primary care providers.
• Identify and flag patients needing expedited follow-up.
• Set up a tracking system for high-risk discharge diagnoses.
• Document all attempts to arrange follow-up appointments.
• Establish clear protocols for tracking and following up pending test results and critical findings that emerge post-discharge.
• Identify any radiology study discrepancies between initial and final reads, and act quickly to notify physicians/patients when needed.
• Document any notifications to physicians or patients regarding communication of test results post-discharge.

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