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Findings Missed? Make Timely Contact with Patient
When contacted by the radiologist with a discrepancy, what should you do first? Attempt to make timely contact with the patient and advise them of the missed finding with instructions and timing for follow up, says Pete Steckl, MD, FACEP, director of risk management for Emerginet, an Atlanta, GA-based emergency medicine management group.
"The severity of the finding determines the urgency necessary for follow-up," says Steckl. "Whereas a missed distal tuft fracture of the finger can be sent for follow up with the orthopedist in a few days as long as it is splinted, a missed 30% pneumothorax would have to return immediately to the ED."
Steckl says there should be verbal contact with the radiologist on all emergent discrepancies with the physician who will be making patient contact.
"A common error is for the ED practitioner to call and leave a message on voicemail and consider that to constitute patient contact," says Steckl. "Aside from obvious patient confidentiality issueswho knows who will be listening to this confidential information?it is impossible to be certain that the patient got the message."
Instead, insist on direct conversation with the patient or his legal guardian. "At times, the phone number is erroneous or disconnected. In this situation, a certified letter should be mailed to the listed address from the chart," says Steckl. "If there is a listed primary care physician, then a call to them notifying them of the finding can be helpful."
It doesn't have to be the ED physician who makes this call, however. "One of our hospitals, a rather high volume 70,000 visit per year ED, utilizes one of the nurse managers to contact and inform patients of nonemergent discrepancies," says Steckl.
However, all discrepancies are initially reviewed by one of the ED physicians who is on shift at the time. "He reviews and triages the charts, and by protocol, any emergent discrepancies are to be managed by him through immediate phone contact. The rest are then handled by the nurse manager," says Steckl.
While all discrepancies should be examined by the ED physician, notification should be managed either by the ED physician or a designated licensed professional depending on acuity, says Steckl. "If the patient cannot be contacted, further attempts must be made and documented until the patient is ultimately contacted," says Steckl. "If, after a preset amount of time, contact is not achieved, a certified letter of notification should be mailed to the listed address on the chart."
Steckl says to document the following:
Time and date of call(s).
Time and date the ED physician or licensed personnel is contacted by the radiologist about the discrepancy.
Time of attempts at contact of the patient and timing of ultimate successful contact of patient.
Documentation of whom is contacted and what information regarding the discrepancy was relayed, along with follow-up recommendations and timing of follow-up.