Another Hospital Question

[Guest guest]

My hospital was just told by the state of California to have all phone orders signed within 48 hrs. Nursing Homes accomplish this by fax, but our hospital is intending to require the attending physician who rounds to sign off the covering physician's phone order the next day. That seems to me to be worse than faxing, since the attending physician cannot confirm that the transcribed order was written accurately without calling the on-call physician. How do others do it at their hospitals?

The hospital here was hit after an audit revealed several admissions to doctors that were not available on the night the admission was made to them. Since the ER failed to notify the covering physician, all charges for these admissions were disallowed and a statement of fraud was filed with the attorney general’s office. After this happened, this policy was quickly rescinded and the patient cannot be admitted to a physician who has not seen the patient personally or at least talked to the ER physician and accepted the patient. We had similar issues where patients were sent to the floor that either shouldn’t have been admitted at all or were admitted to our small rural hospital and we did not have the ability to care for the final diagnosis. There was a huge go round between the medical staff and the administration. I had an issue with them as

well. My malpractice carrier claimed that my policy covered me if I was covering unassigned admits in the capacity of a family physician. This same hospital administration decided to have 2 different call schedules. One for unassigned adults which included both the family doctors and the internal medicine doctors. The peds call schedule included both the family doctors and the pediatricians. However after this change the pediatricians dropped from full privileges to courtesy staff only. What this meant was that family physicians were covering twice the call because of the separate adult schedule. The powers that be refused to understand that by having 2 schedules the malpractice carriers felt that the family doctors were covering twice the call thereby doubling their risk. I refused to take call on different nights for pediatric and adult medicine and I was called before the medical board for refusing to

take call or provide adequate malpractice coverage for my inpatient duties. The malpractice carrier wrote 4 different letters explaining that I was covered for pediatrics provided the admission came as a result of my family medicine call duties and not pediatric specific call. We went round and round for over a year about this. Then the same administration decided to close the OB department and gave me 11 days advance notice to transfer my 38 active OB patients to other doctors at other hospitals. When this happened I made alternate arrangements for admissions and ceased my association with the rural hospital. The point of this story is that the hospital administration will implement any policy that these supposed efficiency experts deemed good for the hospital even if said policy is stupid and poorly thought out from a staff and patient standpoint.

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA 30529

From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Skaggs

Sent: Wednesday, April 28, 2010 3:26 PMTo: practiceimprovement 1 Subject: [Practiceimprovemen t1] admissions thru ER question

Hi All,

Have a question for those who admit to hospital. Our hospital has hired a consultant firm to improve patient satisfaction with our ER "service". They have decided that the best way to make people happy is to shorten the ER stay as much as possible, so they are now wanting to implement a policy where the ER doc decides if the patient will be admitted, and then sends the patient to a floor bed, and THEN the doctor to whom the ER has admitted the patient is notified.

They have started doing this, with silly results: 27 year old with a cough, but no fever is "diagnosed" with "pneumonia", and sent to the floor with no CXR and no CBC. I come order both and find no infiltrate and WBC count is 6..... but the ER length of stay was only 12 minutes, administration is thrilled. But now I have to discharge the patient, who is understandably confused.

My question: has anyone else seen this sort of crazy strategy? I have never seen anyplace where ER docs are allowed to force anybody to admit any patient, much less all patients. -- Annie Skaggs

-- Annie SkaggsLexington, KY