Anyone been running into this lately?

[PapaBear434]

I had a problem one time with the SNF nurse saying that she had already called report to the hospital, and that I didn't need it from her. I asked her for it again, and when she refused I stated, "Well, you will need to call somebody to pick you up from the hospital, because we don't transport employees back to their work."

She stopped for a moment, and then asked me what I meant by that. I replied, "Either I get a report and accept patient care from you, or you come with us and keep patient care during the transport. Doesn't matter to me either way."

I got my report and a phone call from my boss asking me why I refused to accept patient care for a patient. Once I explained what happened, my boss called the SNF and gave them an "attitude adjustment".

That, sir, is AWESOME and will be remembered next time these slacker do-nothings give me this line of crap.

Luckily, I only work rescue, so with the emergent situations they are usually pretty good about just turning over information. But it HAS happened a time or two, people not understanding what HIPPA is actual meant to protect.

 

[Outbac1]

If I go to a home and the staff have no papers for me I tell them what I need and wait for them to get it. I tell them I am responsible for the pt and as such I need to know certain info. If they give me a sealed envelope I open it in front of them and check the contents to see if it is what I need. If they object they get the responsible speech. I've educated a few and some have even learned.

 

[PapaBear434]

If I go to a home and the staff have no papers for me I tell them what I need and wait for them to get it. I tell them I am responsible for the pt and as such I need to know certain info. If they give me a sealed envelope I open it in front of them and check the contents to see if it is what I need. If they object they get the responsible speech. I've educated a few and some have even learned.

I'm throwing the BS flag on this! Liar!

 

[Jon]

That, sir, is AWESOME and will be remembered next time these slacker do-nothings give me this line of crap.

Luckily, I only work rescue, so with the emergent situations they are usually pretty good about just turning over information. But it HAS happened a time or two, people not understanding what HIPPA is actual meant to protect.

Yep.

I work full-time 911 in a community with too many SNF's. That said, I have VERY little issues with our facilities, as I'm on the 911 squad that they called... Hearing these stories brings back the memories of working Transport, and how much that could suck. At some places, it was pulling teeth to get access to even a face sheet, let alone a medication record or H&P. I always tried to re-educate about HIPAA... but that fell on many deaf ears.


As for envelopes:
There was one facility (psych emergency) that insisted on sealing most of the patient's records in an envelope, and would raise a s**tstorm if the reciving facility called because the envelope was opened. They were concerned about their psychiatric evaluations and committment paperwork going missing... becuase there were times when the transport EMT's would lose/misplace the transfer paperwork.
After going back and forth on this, they eventually settled on giving us a sealed envelope with all the documentation, including commitment warrants, as well as a seperate copy of the face sheet, PMH, and medication information. This was adequate for 99% of the patients, so we kept it at that. If I had to open the envelope, I could... I would just have to explain it to a bunch of folks - I never needed to.

 

[ffemt8978]

I should probably add that the one time I said that, it was for a non-emergent transport for a test procedure.

I certainly understand that all information may not be immediately available for an emergent problem.

 

[emtfarva]

I have. Not at a SNF, but a large Hosp group. There was a one floor that would literally yell at you if you even requested a report, let alone a signature. They would tape the envelope shut with a whole roll of tape. Of course we opened it in the truck. Now, they let us see whatever we want. They sometimes won't sign though. I also had this attitude at a psych facility.

 

[CAOX3]

Why would you make a scene in the hospital about seeing someones information. If you need to open in the truck.

Your taking them home for gods sake, do you really need to know the pts whole medical history. Why do you care? The informations there if you need it enroute open it.

This field is really in trouble. If these posts are any sign. All I hear is, Im better then him, Im better then her, give me respect, I deserve respect. Im an EMT, IM a medic.

My God.

How about what ever level you are, you do your job competently, proffesionaly and respectfuly. Stop worrying about what everyone thinks of you and concentrate on doing your job to the best of your ability.

There is a role for everyone, handle your business, people will respect you for it.

Do you need to be showered in praise, constantly told that your an asset to this field, if it wasnt for you I dont know where EMS would be. The constant sesrching for respect and acceptance, its getting really old.

 

[PapaBear434]

Why would you make a scene in the hospital about seeing someones information. If you need to open in the truck.

Your taking them home for gods sake, do you really need to know the pts whole medical history. Why do you care? The informations there if you need it enroute open it.

This field is really in trouble. If these posts are any sign. All I hear is, Im better then him, Im better then her, give me respect, I deserve respect. Im an EMT, IM a medic.

My God.

How about what ever level you are, you do your job competently, proffesionaly and respectfuly. Stop worrying about what everyone thinks of you and concentrate on doing your job to the best of your ability.

There is a role for everyone, handle your business, people will respect you for it.

Do you need to be showered in praise, constantly told that your an asset to this field, if it wasnt for you I dont know where EMS would be. The constant sesrching for respect and acceptance, its getting really old.

Did you just hear a loud whizzing noise flying over your head? Because I think that was the point, and you completely missed it.

I don't think people are really complaining about lack of respect, or even not knowing every little detail about someone when you ship them HOME. It's when it's an emergent (or semi-emergent) situation, or even just taking custody of a patient, which requires you know a base level about the patient you are taking. If they are allergic to something, and the nurse just hands you a sealed envelope and don't tell you a thing about them, something very bad could very well happen.

If we didn't need to know this stuff, they wouldn't teach you to ask for a SAMPLE in basic class.

 

[CAOX3]

Oh no not something very bad.

Sorry when I do calls I dont have the ability to just check the paperwork. I have to use assessmnet. Signs and symptoms should lead you in the direction you need to go in. Sure your paperwork could be helpful. I wouldnt rely on it.

I also dont use acronyms. They were brought about to dumb down the EMT class. I learned pt assessment, do they even still teach that.

 

[amberdt03]

I also dont use acronyms. They were brought about to dumb down the EMT class. I learned pt assessment, do they even still teach that.

they only teach enough of patient assessment to pass national registry. they rest you have to learn on the job.

 

[John Legg]

There seems to be a common denominator in this thread. Lack of education. Locally, we were experiencing the same issues. However, once a representative visited each Nursing Home and Hospital, educated them on what was needed and why, we saw a dramatic change. Now, we receive two envelopes, one for the hospital, one for the crew, with the same documents.

The hospitals now have a discharge transport checklist that must be followed. If applicable, even the Medical Necessity Form is usually completed before we arrive, along with HPI, PMHx and Meds/Allergies. What a change!

Took a little time, cost a little money but ultimately it decreases the head aches and has improved our relationships with those facilities.

John Legg
National EMS Association

 

[PapaBear434]

Oh no not something very bad.

Sorry when I do calls I dont have the ability to just check the paperwork. I have to use assessmnet. Signs and symptoms should lead you in the direction you need to go in. Sure your paperwork could be helpful. I wouldnt rely on it.

I also dont use acronyms. They were brought about to dumb down the EMT class. I learned pt assessment, do they even still teach that.

Your "Holier-Than-Thou" nature aside, you are supposed to receive a turnover whenever you take a patient from another medical professional. Yes, you still do an assessment of your own. But in a lot of cases, particularly in the nursing home cases, your patient is unconscious or unable to tell you anything. Knowing his/her allergies to meds, usual condition, and past medical history is kind of important. Yeah, you can do without those things if you need to, like in emergent cases where you don't have anyone to tell you these things and they are unable to tell you themselves. But if that information is available, and it is perfectly within your scope of practice to know, you should damn well know it.

Do you give a turn over when you turn someone over to an ER nurse, or do you just drop them off in a room and figure the ER assessment is enough? I mean, they have to do it ANYWAY, right?

 

[CAOX3]

they only teach enough of patient assessment to pass national registry. they rest you have to learn on the job.

Actually experience helps but education is the key.

Her are some good books Ive read.

Principle of PT assessmnet in EMS
not sure who wrote this one I let someone borrow it.

Sick not sick
-AAOS

Pt assessmnet handbook
-Richard Cherry

Just because you didnt learn it or werent taught it isnt an excuse, prepare yourself. Even at the BLS level if you cant treat it. It will help everyone involved if you can recognise it.

 

[amberdt03]

Just because you didn't learn it or weren't taught it isn't an excuse, prepare yourself. Even at the BLS level if you cant treat it. It will help everyone involved if you can recognize it.

i totally agree. i'm doing just about everything i can to further my education. granted i can't really treat much but i can recognize it and give the er a heads up.

 

[JPINFV]

Sorry when I do calls I dont have the ability to just check the paperwork. I have to use assessmnet. Signs and symptoms should lead you in the direction you need to go in. Sure your paperwork could be helpful. I wouldnt rely on it.

You're right. All that history, allergies, and medications that are normally documented in the paperwork and fairly easy to find if you know what you're looking for is completely useless in front of the all mighty exam.

 

[CAOX3]

Your "Holier-Than-Thou" nature aside, you are supposed to receive a turnover whenever you take a patient from another medical professional. Yes, you still do an assessment of your own. But in a lot of cases, particularly in the nursing home cases, your patient is unconscious or unable to tell you anything. Knowing his/her allergies to meds, usual condition, and past medical history is kind of important. Yeah, you can do without those things if you need to, like in emergent cases where you don't have anyone to tell you these things and they are unable to tell you themselves. But if that information is available, and it is perfectly within your scope of practice to know, you should damn well know it.

Do you give a turn over when you turn someone over to an ER nurse, or do you just drop them off in a room and figure the ER assessment is enough? I mean, they have to do it ANYWAY, right?

Holier than thou. You hurt my feelings. Actually its confidence in my ability, through experience and education.

I dont have the luxury of recieving a printed manuscript. I have to create it myself. That is done by assessment. Therfore in a case where I would recieve one, no I dont rely on it. Does it have helpful/useful information? Im sure it does.
When a pt has a medical hx as long as my arm, isnt much use if I cant recognise one from another. CHF or pneumonia? CHF or COPD Left sided or right sided failure. I could go on and on.

 

[CAOX3]

You're right. All that history, allergies, and medications that are normally documented in the paperwork and fairly easy to find if you know what you're looking for is completely useless in front of the all mighty exam.

Yes well when they have a hx of everything, and our on every medication under the sun. Thier allergies look the Physicians desk refrence.

Then where are you? Square one. I didnt say it wasnt helpful, I stated I dont rely on it.

Fairly easy to find, Ok well I dont know where you work or with who, but when I recieve these, I would probably have a better chance if it was written by a fifth grader.

 

[RESQ_5_1]

What if your pt is MRSA positive? Which part of your assessment leads you to that discovery? Yesterday, transported an 80 y/o F back to her sending facility after an ORIF on her right humerus (for anyone that doesn't know that would be; Open Reduction/Internal Fixation). Turns out, after she got to the hospital where the procedure was performed, they found she had chronic A-Fib. This was after being seen by nurses, at least one doctor, and at minimum 2 EMS crews. She had an irregular pule at around 120. Generally a good indicator of A-Fib. It was actually caught by the Anesthesiologist who stated he wouldn't sedate her until her HR came below 120.

We do E-PCRs, so I need all that info. Sure, the pt could tell me, but what if my pt is unconcious or doesn't communicate? What if my pt is altered? It's good information to have. I still do my own assessment, but it's a little more focused because I already have information form the sending facility.

Luckily, we don't do transfers from NHs. All of our LTC facilities are located at the hospitals.

 

[PapaBear434]

Holier than thou. You hurt my feelings. Actually its confidence in my ability, through experience and education.

I dont have the luxury of recieving a printed manuscript. I have to create it myself. That is done by assessment. Therfore in a case where I would recieve one, no I dont rely on it. Does it have helpful/useful information? Im sure it does.
When a pt has a medical hx as long as my arm, isnt much use if I cant recognise one from another. CHF or pneumonia? CHF or COPD Left sided or right sided failure. I could go on and on.

Again, you miss the point. The thread conversation had changed from just denial to seeing the chart to nursing home nursing staff not wanting to tell you any pertinent info about the patient. Just take them, here's the envelope, have a good time.

I'm sorry, but a turnover needs to be more than pointing to a body laying in a bed.

 

[JPINFV]

Yes well when they have a hx of everything, and our on every medication under the sun. Thier allergies look the Physicians desk refrence.

How often do you really transport someone with a "history of everything?" Sure, some Dxs are more common than others, but that's just a tad hyperbole.

Fairly easy to find, Ok well I dont know where you work or with who, but when I recieve these, I would probably have a better chance if it was written by a fifth grader.

Primary medical history in H/Ps are generally found in the introduction area, the part labeled "past medical history" or at the "assessment" section at the ending. You don't have to read the entire H/P if you know where to look.