Hi Norm,
Thanks very much for your informative post. I guess I feel kinda lucky now. I receive a fax on every patient that is admitted, and I thought I was singled out, because I have to rotate it 90 degrees counter-clockwise. It is ironic, because I know when they are in, and I follow their course. When I do get the call from the hospitalist, I have to interrupt just for a second to say I have read the ED report, H & P and discharge, just so they know they can just fill in the blanks.
Our neonatologists NEVER discharge a patient without calling us. The irony there is it is either a premie, a septic workup, or a methadone baby. But, I listen intentively.
One thing I NEVER do it call or email a hospitalist to put in my two cents worth even if I think it would be helpful (unless it relates to knowledge I have of the family or patient). That's the last thing I need and really the last thing they need is to think I am second guessing.
There was a time when I could call the ED attending on call and coordinate care that I could not get done in my office, i.e. an IV bolus or IV Rocephin, etc. Now, they are just as likely to see them and send them home with neither. When I emailed the chief of the ED to tell her I have no issue with their doing what they think needs to be done as long as they honor what I have requested. At the very least call me if they think the patient is now sucking down three Mountain Dews. But, she told me quote, "I spoke with all of the ED docs, and they feel like you (being I) do not trust them. So, now I just admit them. Even more ironic, I sent a kid in with periorbital cellulitis for the hospitalist to look at and see if she felt the child needed a CT. I had asked for at least a shot of Ceftriaxone. Turns out they never called her when the child arrived, and they just sent the patient home on Clinda, ignoring the fact that non-typable H. flu can cause cellulitis of the eye. I emailed the ED doctor and simply asked him if he could contact me next time, and he forwarded my email to the ED chief. So, I received another chastizing email. She told me, I should talk to the ED doctor and let him know what I wanted. Wow. Talk about damned if you do and damned if you don't.
I try very hard after reading the ED reports and seeing glaring issues with the care (but usually not enough to truly affect the outcome) to not call or email the physicians. I just feel as though they are doing me a huge favor (in a way) by seeing my patients and generally do a good job. I also think that ED physicians are and should be trained to handle emergencies and not ear infections at midnight.
Anyway, I am going to try to push the lab to send lab results that are pending after the patient is discharged. And, it would be nice if the pending labs were in bold red at the top of the discharge. But, you are right, then I have to check Cerner every few days. But, I could still see an attorney asking me why I checked on the 4th when I could have checked on the 2nd.
At least I can check daily and see if there are any new CMS mandated Transition of Cares in Cerner. They are the first thing you see when you log in. And, to think there are many private physicians who don't even have a Cerner portal. What are they supposed to do?
