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Emergency Room Errors and the Emergency Severity Index (ESI)

June 28, 2023

Emergency rooms (ERs) are almost always chaotic, and many are understaffed, which creates chances for mistakes by medical professionals. These types of errors can result in serious complications or death for patients.

Let’s look at how the priority of treating patients is determined and the types of medical errors that can be committed when procedures aren’t followed.

How Does an ER Determine Patient Priority?

The Emergency Severity Index (ESI) is an emergency department triage algorithm that provides a categorization of patients into groups from 1 (most urgent) to 5 (least urgent) on the basis of the seriousness of the case and resource needs.

The first question in triage asks whether “the patient requires immediate life-saving interventions” or simply “is the patient dying?” A nurse determines this by looking to see if the patient has a clear airway and is breathing, and if the patient has a pulse. Patients who are only responsive to painful stimuli or unresponsive are categorized as Level 1.

If the patient isn’t categorized as a Level 1, the nurse decides if the patient should wait, which is determined by these three questions:

  • Is the patient in a high-risk situation?
  • Is the patient confused, lethargic, or disoriented?
  • Is the patient in severe pain or distress?

A high-risk patient is one who could easily deteriorate, or one who could have a threat to life, limb, or organ.

After the Level 1 and Level 2 questions are determined to be negative, the nurse must ask how many different resources are needed for the physician to provide adequate care and allow him or her to reach a disposition decision—either discharge or admit for observation of care in the hospital.

Before assigning a patient to ESI Level 3, the nurse needs to take the patient’s vital signs and decide whether he or she is outside the accepted parameters for age and are felt by the nurse to be meaningful. If the triage nurse believes that the patient needs two or more resources, the patient will be classified as ESI Level 3.

Those with simpler problems who are likely to need fewer than two resources are assigned to Level 4 or 5. In many hospitals, the triage policy stipulates that all ESI Level 4 and 5 patients can be sent to either the medical urgent care or minor trauma areas of the ER.

What Are Some Common Emergency Rooms Errors?

Errors in emergency rooms include the following types of issues:

  • Medical misdiagnosis. This happens when a doctor, nurse, or other healthcare professional misdiagnoses a patient and either calls the wrong physician to care for them, misinterprets a test result, or misjudges the patient’s symptoms.
  • Failure to perform necessary tests. Some emergency room medical professionals will perform improper triage but ignore patients who need certain tests such as x-rays, in favor of other, less-appropriate tests.
  • Improper medication. Some doctors, if they are provided with improper information or fail to diagnose a patient correctly, may give a patient the wrong medication or treatment.
  • Delayed treatment. Most ERs are consistently busy, and patients may have their treatments delayed to the point where new complications or symptoms develop. This may also occur if a patient is incorrectly triaged, and their symptoms are thought to be less serious than they actually are.
  • No follow up. After being discharged from an ER, physicians must provide follow-up treatment, such as checking for infection after surgery. Not doing this could result in complications or death and is frequently considered to be a form of medical malpractice.

Speak With An Experienced Michigan Medical Malpractice Attorney

Mistakes in the ER by healthcare professionals can lead to further injury, illness, and death.

For a free consultation with an experienced medical malpractice attorney in Michigan, contact Buchanan Firm.

Our firm proudly serves people all across Michigan, including major cities like Grand Rapids, Muskegon, Detroit, Lansing, Holland, St. Joe, and Ann Arbor, and rural towns such as Lowell, Ada, Fremont, Newaygo, Grand Haven, Rockford, and Cedar Springs. We will meet you after hours, at home, or in the hospital to accommodate you.

Contact us today.