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I think we must all be aware of the medicolegal  pressures we must deal with
on a daily basis.Phone calls and cultures are 2 very big issues.
 
Regarding phone calls: unless we are initiating the call, no information
goes out. In the inner city of Detroit, few PCPs are available to the
parents, (let alone the ED docs) so we get many calls. The safest way we can
deal with this is to be very selective on the information leaving the
department. My conversations almost always end with we will be happy to see
your child in the ED or try reaching your PCP.
 
Regarding cultures: we get a print out of all the pediatric cultures and the
results daily to the ED. It is the responsibility of the doc on duty to
review the cultures and see what was done for the positives. If treated
appropriately, no action is taken. We right next to the result treated. If
the patient wasn't treated, we attempt to call the family. If that fails
 usually because the phone number is wrong or none is given) we have the
patient advocate mail or fed ex a letter to the family. All of this is
documented in files we keep in the ED and a copy sent to the medical record.
If the patient was admitted a phone call is made to the floor and this too
is documented.
 
I hate to say it but CYA (B for buttocks if I offend anyone) is a huge
issue.
I hope all this helps. I found it interesting to see what so many are doing.
I am glad many  have similar systems to the one we use at Henry Ford in
Detroit.
Shelley Rubinstein.
 
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:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html