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Journal Article
Emergency physicians should not write orders for hospital admissions
2019
Overview
[...]resident duty hours in Canada decreased in 2013, based on research demonstrating increased medical errors after 24 hours of call.30–33 Additionally, 75% of EPs work in large urban non-academic, small urban, or rural centres.34 In these hospitals, without 24-hour in-house coverage, when a stable patient requires admission, it may be unreasonable to expect an on-call physician to come to the hospital for the sole purpose of writing orders. [...]to do so may limit the daytime care such a physician can safely provide to the community because of increased fatigue-related medical errors. The language used in 90% of the content was information-giving, leaving little time for exploration of issues or confirmation of understanding.37 Relying on this brief transmitter-oriented conversation to safely convey the intentions for ongoing patient care can be risky and may contribute to the significant adverse events attributed to handovers identified by the Joint Commission for Transforming Health Care.38 Policies that advise against EPs writing admission orders are outdated and from an era when EPs were interns and attendings were available to manage ED patients quickly. Diercks DB, Roe MT, Chen AY, Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events.
