The expert also stated that even if the patient had followed up as instructed in the discharge instructions, she still would have lost her finger. According to the expert, whether the patient was negligent for failing to follow the discharge instructions depended on what the patient thought based on the symptoms she was experiencing, not necessarily on what the discharge instructions stated.
Explore This IssueACEP News: Vol 30 – No 08 – August 2011
The defendant physician alleged that the care was appropriate and that he should not be responsible for a bad outcome because application of dressings and discharge instructions are a nursing task and not a physician task.
Issues Considered by the Standard of Care Review Panel
Overview of Management of Fingertip Amputations
The decision on whether to manage a fingertip injury conservatively or surgically depends on the amount and type of tissue loss, the location, and the amount of bony exposure. Treatment of fingertip injuries may be as simple as applying a bandage or may involve skin flaps, skin grafts, or revision of the site for further amputation.
In general, wounds of less than 1 square centimeter without bony exposure require only a nonadherent dressing. Wound contraction will almost always provide a satisfactory cover for the soft tissue defect. While secondary intention takes longer than other forms of treatment (averaging 2 months to heal), several studies have shown that conservative treatment of fingertip injuries results in excellent sensation, function, and cosmetic results when healing is complete.
Wounds greater than 1 square centimeter or involving bony exposure will usually require more extensive treatment and, depending on the emergency physician’s experience and comfort with performing bony revision and skin grafting, may need evaluation by a hand specialist.
Composite grafts (simply reattaching the amputated portion of the digit) have a high failure rate in adults and older children. However in young children and infants, composite grafts remain at least partially viable in 75% of cases.
Are physicians required to reevaluate and unwrap all dressings applied by other allied health professionals?
Wound care and placement of dressings are medical treatments that a physician may delegate to other allied health professionals. Whether a physician is responsible for supervising other health professionals who perform those tasks in the emergency department is a question of law. The Standard of Care Review Panel did not believe that there was a general duty to supervise health professionals performing every aspect of their job functions, although such a duty could be created through state statutes or through a contract between the physician and the hospital or contract management group.