• medico-legal
• risk management
• crowding
• emergency departments

The Emergency Department (ED) has long been considered a ‘safety net’ for healthcare. In the USA this term is often used to indicate that patients who cannot afford to go elsewhere can always receive care in the ED. But as many of us know, the ED is a safety net in almost every healthcare system, regardless of how that care is financed, as it provides a place for patients to be seen out of hours, when general practitioners are too busy, or the patient’s problem is considered too complex for an outpatient evaluation. Although the burden can at times be overwhelming, many of us are proud of the role that the ED plays in their healthcare system: we ensure that patients in need of care receive it.

In their research letter, Price and colleagues demonstrate another way the ED is a safety net.1 We are the default specialty for many malpractice claims, when some of these should be coded as the responsibility of other specialty services. This results in Emergency Medicine (EM) being viewed as a specialty prone to medicolegal claims, contributing to reputational risk and a loss of trust in our service. Moreover, the weight of a legal claim creates high levels of anxiety and depression in physicians, even when they are not at fault, and makes a career in EM less attractive.

It is easy to see why this happens. The terms ‘Emergency Medicine’ and ‘Emergency Department’ are often used interchangeably, even by our own clinicians. Litigation is primarily driven by errors and delays in diagnosis and treatment. As the authors of this research letter suggest, because the majority of hospital admissions come through our EDs, any errors and delays that occur in this location will be automatically attributed to the treating EM clinicians. Delays in specialty consultation after referral, in taking a patient to theatre, or the reporting of CTs and MRIs are often outside the EM clinicians’ control but may result in adverse patient events leading to litigation.

Crowding and boarding of patients in the ED further increases our vulnerability to lawsuits. Care in the ED managed by the inpatient team for a patient awaiting a bed will put us in the frame for any errors, and we often become the individuals responsible for reacting if the patient deteriorates. Finally, regardless of where the incident occurred, lawyers do tend to name every physician in the chain of the patient’s care, so errors that occur in the hospital may still result in lawsuits brought against the EM clinician.

In the UK, at a cost of over £400 million per annum, emergency medicine now accounts for the highest volume and the second highest value of NHS litigation liabilities (after obstetric care). Getting It Right the First Time (GIFRT) have produced a five-point plan for reducing NHS litigation costs: the second point asks that clinicians and managers review the data for claims submitted to NHS resolution in order to confirm correct coding to that department and correct any inaccuracies.2 Wherever we work, it is imperative to set the record straight to ensure that our specialty is protected from inaccurate data reporting. The fallout from misattributed legal action can create yet another tear in our already fragile and stretched safety net.