Case for Improving Communications

Prior use of Live-Vu's carts or kits with our EMR would make the patient's record available in the Emergency Room or anywhere else that he required medical care.

Wednesday, April 8, 2009

A story on AHRQ’s Morbidity & Mortality website makes a strong case for better communication between non-acute care facilities and emergency departments. The case commentary was provided by Christopher Fee, M.D. Assistant Clinical Professor of Emergency Medicine at UCSF Medical Center.

The case highlights the communication failures that can and have occurred between nursing homes and the emergency departments as well as between emergency medical services personnel and emergency departments.

How do failures occur while transporting a patient? In one situation, paramedics delivered a patient to the emergency department and left without speaking with the doctor plus the paramedics did not leave any paperwork or documentation.

The physician managed to find some papers with the patient that identified him as a 68 year old nursing home resident with shortness of breath and some scant notes about his medications but there wasn’t any further information on the patient’s past medical history. Because of the inadequate handoff from the paramedics, the ED physician had no choice but to proceed with the evaluation and treatment of the patient despite only having minimal information.

Although the majority of patients seen in EDs present directly or are brought by ambulance, many are referred from outside facilities such as other EDs, nursing homes, or local clinics. These patients are frequently quite ill and may have received significant medical evaluation or treatment prior to transfer.

Unfortunately, the Emergency Medical Treatment and Active Labor Act (EMTALA) only applies to the transfer of patients to the ED from another ED, hospital, or medical center and does not apply to patients from non-acute facilities.