Current trends demonstrate that the proportion and complexity of emergency care provided by advanced practice providers (APPs) is increasing, which underscores the importance of emergency physician supervision and support. Laws governing supervision vary between physician assistants and nurse practitioners, with the latter legally able to practice independently in some states. Regardless of the supervision model, emergency medicine professional organizations advocate for physician-led teams. Communication lapses and contradictory documentation with errors and omission are potential sources of medical error and risk. Ensuring appropriate oversight with consideration of the APPs experience and documenting appropriately may minimize legal risk.

Medical malpractice is an inevitable truth of being a practicing provider. Despite awareness of malpractice risk, education on understanding the legal landscape and protecting oneself from being named in a malpractice claim is sorely underrepresented in medical school and residency curricula. This review summarizes what is known about the legal risks to the resident in training and the attending physician supervisor. It also explores the legal landscape for physicians practicing and supervising telehealth encounters.

While clinical practice guidelines (CPGs) were developed to help improve patient care, they have increasingly been used as evidence in medical malpractice lawsuits. They are used by both sides in malpractice litigation as a surrogate for the standard of care. Providing care compliant with a CPG can be protective for physicians, but it does not completely absolve them of liability. Providing noncompliant care does carry an increased risk of litigation, but there are several defenses that have been successfully used to defend physicians. Effective communication and comprehensive documentation help mitigate the risk incurred by not following a CPG.

As emergency medicine physicians, we engage in informed consent, have conversations with patients leaving against medical advice, and screen them daily. Better understanding these concepts and processes can improve patient care.

For emergency medicine physicians, being named in a malpractice suit is not an if, it is a when. By the age of 55 years, 68% of emergency physicians have been sued. In the following article, we review the most common factors shared by closed claims in adult and pediatric patients from emergency departments and acute care settings. Our hope is that by identifying shared characteristics, we may improve patient care and reduce litigation risk.

Meningitis, appendicitis, and testicular torsion are among the most common conditions resulting in malpractice litigation in Pediatric Emergency Medicine. With meningitis, most litigation claims involved patients <2 years old. Notably, 25% of patients had no fever and many lacked classic signs of meningitis. For appendicitis, nearly 3/4 of litigated cases claimed delayed/missed diagnosis. A non-diagnostic ultrasound (eg, no appendix visualized) has a negative predictive value of only 86%. Finally, testicular torsion carries a 34-42% testicular loss rate and 10% of patients with torsion only present with isolated abdominal pain. Atypical presentations must be considered and clear return precautions are imperative.

More than 75% of emergency physicians will be named in a malpractice suit over the course of their careers. When a case is brought to trial, it is the chart that will be the primary source of information, not the faded memories of an encounter that happened years in the past. Being mindful of all 3 audiences that the chart is generated for and developing techniques to adequately address all 3 should be the focus of the clinician when documenting a patient encounter.

Headache is a common complaint of patients in the emergency department. The large majority of them have self-limited causes but some have life, limb, brain, or vision-threatening secondary causes. The job of the emergency physicians is to distinguish the 2 groups. This article focuses on clinical tips to avoid or at least mitigate medico-legal risk in patients with headache. Each process of care-history, physical examination, laboratory testing, brain imaging, spinal fluid analysis, specialist consultation, and documentation-will be considered.

Chest pain is a common chief complaint in the emergency department. When looking at patients with chest pain cases of acute coronary syndrome, pulmonary embolism and aortic dissection account for the majority of cases that involve an allegation of malpractice. While it is likely impossible to catch all these cases having a structured approach to these patients may improve outcomes for both patients and clinicians.

Misdiagnosis in Emergency Medicine can be associated with patient harm, with neurologic diagnoses among the most common conditions to confound physicians. These are often complex, time-sensitive and nuanced, offering opportunity for mimics and chameleons to make assessment, diagnosis and treatment challenging. This article discusses the legal considerations pertinent to neurologic diagnoses for the emergency physician, including assessment, diagnosis, treatment, transfer and documentation in order to ensure excellent patient care as well as protection from liability.

The balance between risk of missing serious disease and potential harms from over testing involves knowledge of the literature, familiarity of clinical guidelines, incorporation of clinical decision tools where appropriate, use of metacognition to be aware of cognitive decisions to respond and use of shared decision-making in the context of a patient's presentation and with the guidance of the clinician.

Abdominal pain accounts for approximately 10% of emergency department visits and 4% to 6% of litigation. Clinical history and examination are important, as all diagnostic testing has limitations. Specific pathologies, such as appendicitis, warrant a review of factors increasing risk. In all cases, documentation of prompt communication with consultants can be protective in the event of any unforeseen delays in care. Careful attention should be paid to special populations including patients with cancer, diabetes, and patients with postsurgical, geriatric, and bariatric surgery.

The majority of physicians will face at least one medical malpractice claim over the course of their careers. The stress caused by medical malpractice claims can lead to litigation stress or malpractice stress syndrome. Physicians experiencing a claim may have strained family relationships, worsening anxiety and depression, and burnout, and have higher rates of medical errors. In such cases, physicians should seek support of their legal counsel and from a licensed professional therapist. Above all, physicians should remember that malpractice claims are an occupational hazard and not a sign that they are a bad physician.

Good decision-making, solid notes that show care and a reasonable thought process, and skillful interpersonal dealings with patients and loved ones are keys to avoiding claims and lawsuits related to care in the emergency department (ED). This means taking measures to control the brisk assembly line of work in the ED so that important steps such as assessment, testing, treatment, and communication promptly occur without any dilution in quality. It is crucial that the physician in the ED displays excellent bedside manner, including dealing with an increasing challenging patient population and the family and friends who often accompany them.

The management of patients in shock or arrest is a critical aspect of emergency medicine and critical care. Rapid and accurate assessment is paramount in determining the underlying causes and initiating timely interventions. This article provides a summary of essential ultrasound protocols for the critically ill patient including the extended focused assessment with sonography for trauma (EFAST), rapid ultrasound for shock and hypotension (RUSH), and sonography in hypotension and cardiac arrest in the emergency department (SHoC-ED).

One cannot successfully employ point-of-care ultrasound (POCUS) without a process to provide support and guidance. POCUS administration is a multifaceted topic that demands the utmost attention from those responsible for program implementation and long-term execution. This article delves into POCUS administration and is meant to serve as a guide for the practitioner seeking to start, maintain, or augment their POCUS program.