We do feel obligated to follow up cultures sent from the ED and urgent
care. OUr mechanism is as follows:
Negative cultures are never reported and get no follow up.
Positive cultures read in the lab each day (includes strep swabs,
pertussis, blood and urine and wound cultures) are printed on a printer in
the ED. The urgent care nurse finds the chart for each culture (we keep a
triplicate copy on file in the ED for 30 days) and looks to see what was
done. If patient appropriately treated then the RN makes a note on a
culture follow up sheet. These and un-tx (or resistant) patients are given
to the attending who reviews and signs each sheet. If pt admitted the
admitting service is paged to assure they are aware of results. Patients
who need changed or new Abx called in are called by nurse and medications
are called to pharmacy. Pts who are worsening/etc are called back to ED
I think that if you are the ordering MD for cultures and don't follow up
positives then there is significant liability involved. Obviously an
iron-clad follow up plan (ie next day with PCP) will lessen that liability.
HOwever I have read claims where patients saw PCP after an ED visit, were
mis-diagnosed/managed, and both PCP and ED doc get sued, so if the PCP
doesn't follow up the culture results I don't think we're off the hook.
Plus its good patient care and customer service to follow these results up.
Virgil Davis, MD
Univ of Az, EM
At 02:00 PM 12/10/99 -0500, Norman C. Christopher, MD wrote:
>I wonder if there is any concensus as to how to handle telephone calls
>by patients/families looking for results of labs/cultures? Knowing that
>most ED's have a policy discouraging entertaining such requests, does
>any one feel "obligated" by medicolegal pressures to respond by giving
>For example, a patient fails to improve after discharge from the ED (to
>make it easy, say it's an infant with fever and no other source), a
>parent calls asking for information, knowing that a culture is pending,
>they are told by a "staff person" that "it's against policy to share
>such information by telephone", the caller is angered, the patient does
>poorly, etc etc.
>How does everyone handle such situations? Do you call families or
>patients with positive cultures obtained in the ED? (for example, a
>child suspected of having a UTI at the time of discharge is placed on
>amoxicillin empirically - the culture grows amp-resistant E coli, and
>sensitivity testing suggests a change in therapy). Do you have a
>mechanism in place, or do you feel responsible, to follow up with these
>We are re-evaluating our current process, and would appreciate any input
>that you may have. Thank you.
>For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: