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Morbidity and Mortality

Morbidity and Mortality. Dr. Claritza Rios Dr. Brijal Patel Dr. Trushar Naik. Kings County Hospital Center SUNY Downstate Department of Emergency Medicine. History. Physical. Labs / Radiololgy / EKG. Assessment and Plan. ED Course.

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Morbidity and Mortality

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  1. Morbidity and Mortality Dr. Claritza Rios Dr. Brijal Patel Dr. TrusharNaik Kings County Hospital Center SUNY Downstate Department of Emergency Medicine

  2. History

  3. Physical

  4. Labs / Radiololgy / EKG

  5. Assessment and Plan

  6. ED Course • If relevant to case, include time stamps & dates (most cases have time as an important factor) • May need few slides

  7. Was standard of care met?

  8. What went wrong? / Points of Error

  9. Types of Errors Description of types of error Does it help to classify errors in the case?

  10. Clinical pearls (1-2 slides) • If something clinical was involved – such as missed diagnosis, non-recognition of sick patient – include relevant pearls • Red flags for why this patient has potential for bad outcome • Possible important clinical clues to the final diagnosis • Pitfalls encountered in this diagnosis • Avoid the broad overview of clinical diagnosis unless it’s something rare and few people are aware of it

  11. Systems Issues (2-4 slides)This should be an important part of presentation • What else went wrong that led to bad outcome? • Busy ER • No repeat assessment • Delays in care • Radiology • Med admin • Consults • Etc

  12. Process Improvement • What can we do to fix problem? • Is a change in policy needed? • Education of Drs re: clinical diagnosis • Improvements to nursing/ancillaries • Communications w/other depts – radiol, consults, admitting services • Etc • How can we change our thinking/actions to avoid the pitfalls

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