Hi there Norm:
In our department the third year peds resident is responsible for calling
the families for all patients with positive cultures who were discharged,
and all positive x-rays that were missed. They usually attend to these in
the am when the ED is less busy. We keep a log book of all positive
cultures and the residents also write addendum notes to the ED medical
record regarding any actions taken (for cx's or xr's). Although perceived
by some as "scut" most appreciate that the system is time tested and works
well. The issue of confidentiality is problematic for us as well,
especially for positive STD cultures.
Other issues that have come up with our system:
1. Despite our best efforts, often the phone/beeper number that the
family gives us is incorrect. At times we have to contact the PMD, or send
the police out to bring patients back to the ED
2. We serve a large Latino and immigrant population. Communication by
phone can at times be challenging.
We have found that as with medicine the best treatment is preventative:
* Tell the families why we are asking for their phone numbers. We
usually tell the families why we are asking for their number as some are
otherwise reluctant to give us their true phone number.
* Anticipate barriers to communication (e.g., language)
* Plan for a mechanism to report STD cultures at the time of the
patient's ED visit.
Zach Kassutto, M.D.
St. Christopher's Hospital for Children
Email: [log in to unmask]
----- Original Message -----
> Date: Fri, 10 Dec 1999 14:00:28 -0500
> From: "Norman C. Christopher, MD" <[log in to unmask]>
> Subject: callbacks by patients discharged from the ED
> 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.
> Norm Christopher
> Children's Hospital/Akron
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