Emergency Department Complications$-$ Case for Chapter $13,7$ and $17.$Textbook Page $463-464$ by Rachel AksharChester Hill regional hospital is a large urban hospital located in Arkansas, dedicated to improving the health of its local community. Due to a recent shut down of another facility, Chester Hill has seen a dramatic increase in their inflow of patients, specifically within the emergency department.The hospital is currently short$-$staffed and many employees feel overworked and burn out. The Friday & Saturday shifts are predominantly bad, and almost all the nurses & physicians dread coming to work. During a very busy Friday evening, a $47$ year old female patient, Mary, came into the emergency department complaining of serious abdominal pain. The patient had been drinking throughout the day due to a family event, and upon entry her blood alcohol level was $\mathrm{.}301,$ which left her seriously impaired. When evaluated by the admitting nurse, Mary noted her pain as $8$ out of $10.$ Dr$.$ Edward Dennis, one of the emergency department physicians, briefly reviewed the chart and immediately ordered fluid and pain medication.Dr$.$ Dennis ordered that the patient be monitored every $20$ minutes and noted for the nurses to keep an eye on the patients blood pressure for any dramatic jumps.As the emergency department continued to fill with other patients, Mary was moved onto an overflow room. Nurses were extremely busy with other recent admitted patients; therefore no one was able to closely monitor Mary blood pressure. As Dr$.$ Dennis returned to check back on Mary several hours later, he found her in cardiac arrest. Despite the efforts of Dr$.$ Dennis and the rest of the emergency department staff, they could not resuscitate Mary. An autopsy revealed the cause of Marys death was blood alcohol content, mixed with hydromorphone.As Dr$.$ Dennis and the ED nurses reviewed the autopsy results and reflected on Marys case with the hospitals CMO, Dr$.$ Dennis instantly became defensive. He quickly explained that he was unaware of the patients blood alcohol content, and if he had known, his course of treatment would have differed. In addition, Dr Dennis expressed that he assumed the nurses would have monitored the patient closely and administered the appropriate amount of pain medication, based on Marys response.On the opposite end of the spectrum, the nurses attested that Dr$.$ Dennis never ordered, the patient to be closely monitored.Discussion questions:$1.$ What are the primary issues and concerns in this case?$2.$ How can Dr$.$ Dennis and the rest of the ED staff ensure they communicate effectively during busy shifts.?$3.$ How might teamwork be beneficial and prevent this type of medical error from happening in the future?$4.$ What liability does Chester Hill Regional Hospital have in this case?$5.$ In order to prevent his type of incident, how must Chester Hill address the staffing of its emergency department?$6.$ You are the Chief Medical Officer assigned to investigate Marys case. How do you effectively address Dr$.$ Dennis.?