Risk management in suspected acute appendicitis

Acute appendicitis is a disease in which the essential elements for timely diagnosis are available. These elements are a careful history and thorough physical examination, the latter repeated as necessary until clinical judgment indicates that exploratory surgery should be performed or the patient safely discharged. The hospital that does not provide its staff with facilities to do so invites a potentially successful malpractice claim. In the absence of properly documented care, such a claim could include allegations of improper or inadequate evaluation of a person presenting for medical care, negligent medical care based on failure to properly use referral and consultant sources, and failure to provide adequate follow-up (including hospital admission). Such allegations would describe the foreseeable and significant consequences of the adverse event, be it premature discharge or negative exploration. Risk management includes education of hospital administration about the importance of an adequate observation period in this diagnosis, and education of the professional staff about the need for thorough documentation of the serial examinations when surgery is deferred. This article has presented fact, references, and opinion, which should help hospital risk managers to assess the documentation of appendicitis cases now being seen in their hospital, to plan educational interventions with the administration and professional staff, and to assist the hospital collections personnel if payers contest admissions that did not result in surgery.