Positive Outlook - Issue 6.0 - May 2014

Between a Rock and a Hard Place
Anti-coagulation following elective or emergency surgery has become a dismal swamp of litigation.  Should a post-op spine decompression be anti-coagulated?

If not, and the patient develops a significant or life threatening PE, you could be sued. On the other hand, if you do, and the patient develops a postop hematoma and neurologic loss, you may also be sued.

What about a patient who has a fracture, but also takes Plavix for their atrial fibrillation? Plavix is great for atrial fib but may be viewed by the plaintiff expert as sub-optimal for postop DVT prevention even with early ambulation.

How about compression socks and mechanical compression… Are they sufficient in cases where anticoagulation carries significant risk of complication?

How does your office handle the non-emergent phone calls such as, “I have some leg swelling.” Is the response recorded in a phone diary? What do you tell the patient? Who tells the patient? Should every leg-swelling event undergo an ultrasound? Is this defensive medicine or good medicine?

One thing is certain – it’s easier than being deposed.

Pulmonary embolus is a very real problem and carries a very real litigation risk.

While total joints have a well-established set of guidelines, the realms of trauma, elective surgery and spine surgery are less defined.

As a doctor driven insurance carrier, we are not here to tell you, or your doctors, what to do. However, we are here to help you in any way we can.

What’s the Solution?

  1. Consider Ultrasound as a standard for complaints of leg swelling.
  2. Record instructions to patients with regard to early ambulation, and consider dictating notes for the reason anticoagulation will not be given due to bleeding risk.
  3. Consider ASA as a standard order for any lower extremity injury or for patients with lower extremity cast.
  4. Act defensively if in doubt.

As always, we would love your input. Please contact Janet McCrossen or me with your feedback.