Goals:

1. Be steps ahead of malpractice lawyers.
2. Improve reimbursement for services provided.
3. Efficient transfer of information.
4. Legible records.

Strategies:

1. Corrective feedback: Information recorded in a functional format can guide in responding to the information at hand, in a timely and correct fashion, e.g. altered mental status; abnormal potassium, blood gases, heart rhythm, blood pressure, blood count, hypoxia, pain level, medications given, intake and output, comments, etc. Recording the data on a spread sheet minimizes the risk of data being unrecognized, unreported or late in being reported. This tool, the ER DATA FLOW SHEET can minimize these risks and reduce the risk of patients dying with inappropriate care (1). Entries are made by all providers, physicians, nurses, and respiratory therapists. Audit/review of care with the team can be done quickly and instruct and encourage all those involved. [One of the first things a malpractice lawyer does is to put all the data on a spread sheet].

2. Improve reimbursement: It is easier and more accurate to determine the complexity of the care process, the procedures done, and the amount of critical care time when recorded in a standard format. These components of care can be easily overlooked or difficult to assess when recorded randomly or inconsistently.

3. Efficient information transfer: Providing the recipient (next provider) of care with the details involved in the process of care on a spread sheet (ER DATA FLOW SHEET), along with a brief narrative of the precipitating event(s) is efficient and helpful. Transfer of patient information verbally is time consuming. With a multitude of documents (often 10 - 15 separate reports) critical data can be overlooked. A spread sheet can accurately portray the process of care and can be grasped in a few seconds (2).

4. Legible records: Pre-printed headings identify what is being entered. Initial physical findings are entered in the box at the lower left corner of the ER DATA FLOW SHEET, prompted by printed headings. Pre-printed headings gives the reader a 'heads up' on what is being entered.

Reference:

1. Wachter, RM, Shojania, KG. INTERNAL BLEEDING: The truth behind America's terrifying epidemic of medical mistakes. New York, Rugged Land. 2004.
2. Cross H. A data flow sheet for managing unstable patients in the emergency department. Jt Comm J Qual Patient Saf. 2006 Apr;32(4):221-4.

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