weird abbreviations in my company

[gastro18]

Bolded section:
Except... it's not, unless you're lying on your run report. The documentation regarding medical necessity isn't just from the ambulance PCR, but also from the patient's medical record, as attested to by other health care providers (i.e. physician certificate of necessity, which can be signed by several other providers besides physicians). If you are faithfully documenting your assessment, then you're going to be a part of the reason why any call is, or is not billed, and whether a patient is continued to be given service or dropped.


Additionally (and this is directed to the entire concept of the provider as a party to billing), you do like getting paid, correct? The simple fact is that one of the reasons for a PCR is reimbursement for services and this should be one factor in determining how a specific case is documented. The single most important factor? No. Additionally, no factor is worth lying over. Personally, I'd love to see providers docked pay if a continuing lack of proper documentation (lack of proper documentation is not the same as a lack of necessity) leads to billing issues.

Thank you for the reply.
However, after two years working in this company, I never got a PCR come back to me because we weren't able to bill from my documentation. The key is accurate and complete assessments. They cover all bases when it comes to determination of ambulance necessity. And I do like getting paid. Like what you said, there's really no point lying, so long as you document what you see, hear, smell, etc. For example:

A patient gets discharged from the ER, after a fall from her SNF, so you go

"86 y.o. female Pt c/c approx. 2 cm LAC @ R supraorbital arch, S/P fall, found @ ER, alert & orientedx1, semi-fowler's @ ER bed, with no acute distress. Pt going back to SNF, D/C from ER. Pt. has Foley cath & G-tube, stage III sacral ulcer with clean, dry, intact drsg. Pt Hx of Falls, seizures, COPD, DM, HTN, CHF, ESRD and peripheral neuropathy. ------(then continue assessments)... (transport maneuvers)... (interventions, if any)... (etc. etc.)

In this case, my incident, c/c, assessments, etc say it all. This pt needs an ambulance. And it doesn't need me saying "Pt needs an ambulance because....blah blah blah". it's just simple I-CHART charting. And it works!

Now, if a patient is 45 y.o. and only has DM and chronic head pain as Hx, with a c/c of pain in the forehead, with no tubes and no weakness and found ambulating in the hospital parking lot, smoking a cigarette, then I'm going to just write what I see and hear, to the best of my ability. If we transport him to his apartment because we need to honor the contract we have with the calling facility, and find out later that we are not going to get paid, then so be it. Write it off as "marketing expense". Or maybe market for better calls.

In this situation, a lof our newbies find themselves in a situation, unsure of what to write in the portion of the PCR where it says "Pt needs an ambulance because________". Especially for pts like the one i just mentioned. This puts rookies in the griller for DOJ, DHS, NREMT and other agencies who might feel like prosecuting when the (blank) hits the fan.

That's the reason why I don't even use that phrase. I just do my job within my scope of practice. This keeps me out of trouble, and out of management's nose.

 

[gastro18]

Do I understand you correctly?

You can listen for and document a distant heart tone but not a rub?

You can Report murmers but not a stenosis or regurgitaton? Were you absent that day when they mentioned it is the same thing?

So how do you know that you have an S3 or S4 sound and not a split S2?

I doubt you know the significance. But I'll give you a shot.

Why would S2 be split? What if the split duration is wide vs. narrow? What is happening in the heart? Why is it happening? How do you know you are not hearing a early ejection sound?

When is S3 physiologic? How do you know if it is pathologic?

You said you can hear and document S3 and S4. Did anyone bother to tell you or maybe it was in the book that heart tones correspond to actions of the heart?

That those series of noises can tell you where a signal was originating from?

When you learned the difference between vtach and svt on a monitor you were of course told the electrical activity does not always correspond to the physical activity.

No palpable pulses in an obese person? I have seen patients who weigh 800+ lbs who have readily palpable distal pulses. Press harder.

If a pt has no pulse from dehydration that crosses the line over to life threatening hypovolemia. If they weren't dead they would still have central pulses or you would be doing CPR.

I strongly encourage that if you don't know what you are listening to or for when you listen to heart sounds you not write on a run report you heard specific heart tones. (or even bothered to listen for them until you learn about them)

Those guys in the 1600s clearly were more capable medical providers than today's BLS. Maybe that's why they were called "doctors?"

Incidentally, it was a physician who told me that little gem when he was teaching me how to listen to heart tones and diagnose SVT. (back in 2002)

I'd be happy to hear any more insight you have on the matter. perhaps you would be so gracious as to share your wisdom with me?

I have a few insights on what EMT-B are and are not permitted to do. The next time an EMT-B tells me they can do the same assessment as ALS I am going to just link to this thread.

As one of my favorite professors likes to say "That stethoscope hanging around your neck isn't a piece of jewelry. It has a purpose, learn how to use it."

You're right from the very beginning... you don't understand me correctly.

Sir, when I said murmurs, it's the abnormal swooshing sound heard via auscultation. Stenosis and regurgitation are very different physiological processes but they both produce characteristic murmurs. As for describing different types of murmurs and their origins, it's not my job. That is for physicians. Or maybe guys like you.

If I hear a murmur, then I report it. As for rubs, I haven't encountered it yet. If I come across that grating sound as described on textbooks, then I might just use the same exact words -- "there appears to be a grating sound" -- instead of writing "friction rub". As for the extra heart sounds, as an EMT-B, I only have the capacity to report any extra beats heard separately from the two beat "lub-dub" heard on normal patients. If I hear 3 beats, then there's an S3. If I hear a fourth beat, then there's an S4. I don't have the capacity to distinguish between split S2, or wide, or narrow, or pathologic, or physiologic. I just report what I hear. I only operate on a BLS level sir.

And I'm not saying that I'm right. A cardiologist would soon enter the ER and come up with a diagnosis. Then he might say things like "split S2" and some such. At that point, it's not my problem. All I did was report to the doc what I heard. I go, "Doc, I think there's an S3/S4". I don't make diagnoses such as split S2, MS, AS, MR, AR, PDA, VSD, etc. why? because I'm not a doctor. I'm just an EMT-B.

You tell me I am expanding my own scope of practice and doing ALS stuff by reporting these extra sounds? No sir, I just report what I hear -- (swooshing sounds) "murmurs", and extra heart sounds (S3,S4). that's all. I don't have the scope and training to be messing with big boy stuff. I'm an EMT-B. I'm not saying I'm smarter than you. You probably know more than I do.

My business is to listen for murmurs, extra heart sounds, and check if they're beating regularly or not. and then I report them! that's it! How did it become ALS practice?

As for SVTs? I don't deal with them! I'm just an EMT-B. However (and you'll probably hate me for saying this) all I know is that you can't diagnose them without an EKG. Coz you gotta know where those multinodal impulses are coming from.

 

[JPINFV]

If I hear a murmur, then I report it. As for rubs, I haven't encountered it yet. If I come across that grating sound as described on textbooks, then I might just use the same exact words -- "there appears to be a grating sound" -- instead of writing "friction rub". As for the extra heart sounds, as an EMT-B, I only have the capacity to report any extra beats heard separately from the two beat "lub-dub" heard on normal patients. If I hear 3 beats, then there's an S3. If I hear a fourth beat, then there's an S4. I don't have the capacity to distinguish between split S2, or wide, or narrow, or pathologic, or physiologic. I just report what I hear. I only operate on a BLS level sir.

I just want to make sure I'm reading this right. You're saying that heart sounds is an S3 and 4 heart sounds is an S4?

And I'm not saying that I'm right. A cardiologist would soon enter the ER and come up with a diagnosis. Then he might say things like "split S2" and some such. At that point, it's not my problem. All I did was report to the doc what I heard. I go, "Doc, I think there's an S3/S4". I don't make diagnoses such as split S2, MS, AS, MR, AR, PDA, VSD, etc. why? because I'm not a doctor. I'm just an EMT-B.

Saying that you observed a clinical sign isn't making a diagnosis. Reporting you heard an S3 isn't any different than saying you observed Marcus Gunn or Argyll Robertson pupil, or observed a Babinski sign.

 

[Lifeguards For Life]

Y
. As for the extra heart sounds, as an EMT-B, I only have the capacity to report any extra beats heard separately from the two beat "lub-dub" heard on normal patients. If I hear 3 beats, then there's an S3. If I hear a fourth beat, then there's an S4. I don't have the capacity to distinguish between split S2, or wide, or narrow, or pathologic, or physiologic. I just report what I hear. I only operate on a BLS level sir.

attached is a link discussing heart sounds, sans jargon.

http://www.chfpatients.com/faq/s3s4.htm

http://depts.washington.edu/physdx/heart/demo.html

 

[MSDeltaFlt]

There are additional reasons besides immobility or being bed confined for ambulance transport (off the top of my head includes psych, communicable diseases requiring isolation, need for monitoring, and many more). Also, I highly doubt that those two are living in facilities where transport would be needed. On the other hand, there are plenty of patients who, for a variety of reasons, are unable to function that independently due to things like amputations or other events in their health history.



I'm going to disagree with this because if this is true, then we can't do the opposite. Following this argument, you can't document shallow breathing (low tidal volume) without a spirometer either yet describing (even if it's just a gross observation) the quality of respiration is a normal part of any assessment.

First off those were only 2 examples of reasons why blanket statements of "CVA", "Bilateral Amputee", and the like won't work. You must give reasons why they need an ambulance, not just put down a Diagnosis. Insurance complanies don't give a rat's hairy @$$ what their problem is. All they want to know why they have no other choice than to go by ambulance. Which is why you need to explain in detail in order to bill insurance properly and not run the risk of being indicted on the federal violation of insurance fraud. And yes, you the one filling out the billing form, will be the one getting into that kind of trouble.

Secondly, "normal tidal volume" emplies you used some form of measurement. "Shallow breathing" emplies you used clinical observation. It's in the same genre of stating a radial pulse is this BP, a carotid pulse is this BP, and so on and so forth.

What do you think? What do you know? What can you prove? You can only chart what you can prove in black and white and beyond reasonable doubt.

And what was placed at the end of my post? Follow your Policies and Procedures.

 

[Veneficus]

Res Ipsa Loquitur

You're right from the very beginning... you don't understand me correctly.

I think I do... You tried to call me out on something you have absolutely no idea about. Then you tried to hide behind "just being an EMT" when I accepted your challenge and gave you a fair chance to show your stuff.

Sir, when I said murmurs, it's the abnormal swooshing sound heard via auscultation. Stenosis and regurgitation are very different physiological processes but they both produce characteristic murmurs.

Both Stenosis and regurgitation produce "swooshing." it is when and where you hear the "swoosh" that decides the difference. Where and when you hear sounds determines whether you hear an S1, S2 (split or not) S3 and S4.

How many times have you actually listened to heart tones? I am convinced you never actually learned or understood heart tones and are just pretending to. For what reasons I have no idea.

As for describing different types of murmurs and their origins, it's not my job. That is for physicians. Or maybe guys like you.

Yea, physicians and guys like me I guess... But my hope is eternal if you are going to report something, you actually know what you are talking about. I also hope if you are going to represent yourself as being knowledgable about what can and can't be done in medicine you have some accurate idea.

If I hear a murmur, then I report it. As for rubs, I haven't encountered it yet. If I come across that grating sound as described on textbooks, then I might just use the same exact words -- "there appears to be a grating sound" -- instead of writing "friction rub". As for the extra heart sounds, as an EMT-B, I only have the capacity to report any extra beats heard separately from the two beat "lub-dub" heard on normal patients. If I hear 3 beats, then there's an S3. If I hear a fourth beat, then there's an S4. I don't have the capacity to distinguish between split S2, or wide, or narrow, or pathologic, or physiologic. I just report what I hear. I only operate on a BLS level sir.

The poor creature, he doesn't know any better...

How many cardiac tamponades have you come across to know what distant heart tones sound like if you can't hear a rub because you never heard it before and only read about it in a textbook?

And I'm not saying that I'm right. A cardiologist would soon enter the ER and come up with a diagnosis. Then he might say things like "split S2" and some such. At that point, it's not my problem. All I did was report to the doc what I heard. I go, "Doc, I think there's an S3/S4". I don't make diagnoses such as split S2, MS, AS, MR, AR, PDA, VSD, etc. why? because I'm not a doctor. I'm just an EMT-B..

Trust me, forget you ever heard the terms S3 and S4, say nothing about it. The person you give report to will think much better of you.

You tell me I am expanding my own scope of practice and doing ALS stuff by reporting these extra sounds? No sir, I just report what I hear -- (swooshing sounds) "murmurs", and extra heart sounds (S3,S4). that's all. I don't have the scope and training to be messing with big boy stuff. I'm an EMT-B. I'm not saying I'm smarter than you. You probably know more than I do.

I didn't tell you to expand your scope, you said you were listening to and reporting heart tones. What I did was point out you don't know how.

If you can't tell the difference, then you don't know if you heard a split S2 or an S3 or S4? A split S2 has an extra sound it is most certainly not an S3 or S4. If you report an S3 because you heard an extra sound and it was infact another sound, you are giving an erroneous report. especially bad if you actually erroneously document a patient condition on your run report. Better to say nothing about it at all. Then you are not wrong.

I wonder how you would fare in court if you are called to defend your care or documentation when it is pointed out you are writing things on a PCR you don't actually know about. I would wager it would call into question everything else you wrote/did and it would make for a very bad day.

My business is to listen for murmurs, extra heart sounds, and check if they're beating regularly or not. and then I report them! that's it! How did it become ALS practice?.

(my comment removed in the effort to be kind and make this somewhat educational)

all I know is that you can't diagnose them without an EKG. Coz you gotta know where those multinodal impulses are coming from.

On this, you are simply mistaken. A case of not knowing how much you don't know.

Super ventricular tachycardia means that the signal is originating above the level of the ventrical at greater than a certain rate. By definition it does not define exactly where above it. The sounds the heart makes are distinctly different when the ventrical is the primary pacemaker. with the exception of PEA the mechanical function of the heart directly correlates with the electrical function. When you look at a rythm on and EKG you are equating the mechanical function with the electrical function. When you listen to heart tones you are doing just the opposite. You correlate the electrical function with what you hear happening mechanically.

It is a fact that not all rythms can be identified by heart tones. SVT is one that can be. (Probably why it is so vaguely defined)

I really need to start charging for this stuff.

 

[Shishkabob]

I'm just an EMT-B.

No such thing.








And there is nothing wrong with writing "Reason for Ambulance". In fact, AMR has it on their paper PCRs, and seeing as it is the single largest provider in the US, and Medicare hasn't made a fuss, my money is on it's ok. So long as you aren't making anything up, it's all legit.

 

[EMSLaw]

Thanks for the reply!
Sir, we (EMT-Bs) are actually authorized to auscultate heart sounds because sometimes the patient circles the drain and next thing you know the patient has no peripheral pulses. Or the patient has no palpable pulses because of the patient's condition (i.e. amputee, obesity, dehydration). The job then is to auscultate for the apical pulse and determine if the patient is still alive, or if the heart is beating irregularly or regularly, or muffled (tamponade), or absent -- heart sounds. Sometimes we get funny sounds too. Of course we are only limited to basic descriptions like "murmur" or "gallops" (extra heart sounds S3, S4), and these too can be documented. We just don't go documenting VSD, Mitral Stenosis, Friction Rubs (even if you know), simply because we are just BLS.

Sure, auscultate away. You're not going to hurt the patient. Looking for clinical signs can be educational - I certainly do it - but unless you're certain of what you've found (and certain you know what you're looking for), I wouldn't include it. I wouldn't base my treatment, at the EMT-B level, on the findings of apical auscultation, for example. It's right up there with percussing an abdomen (by the way, if you're going to auscultate the bowel sounds, do it before you palpate or percuss) or percussing or palpating the lung sounds. Knock yourself out.

As far as it being within your scope, show me where auscultating the apical pulse is in the DOT scope for an EMT-B? I certainly didn't learn that in EMT-B class, but maybe they go more in depth in your state. Maybe Veneficus or JP would care to tell us how many hours they spent learning about what to listen for? I guarantee that it's way more than any of us.

 

[CAOX3]

Oh boy assessing vetricular and atrial gallops at the BLS level.

Well I usually place my patient supine or left lateral position depending on size so I can accuratley assess, determine and differentiate S3 and S4 sounds, this positioning will make it easier for me to determine if its actually summation which would greatly change my treatment strategy at the EMT level.

Lord just take them to the hospital please.

This could have gotten ugly quick if it werent for the professionalism displayed by Veneficus and for that sir you recieve + 1.

Later.

 

[MonkeySquasher]

You can't exactly write (if your company wants to get paid) "Patient was ambulatory and appeared to be in no acute distress, but required an ambulance because, 'I don't have a car and need to get to the liquor store near the hospital.'" Or whatever other reasons, beyond a medical emergency, people call ambulances.

Actually, I do. And I get yelled at by management for it. My job is to document the facts, and in my system, bull:censored::censored::censored::censored: private transports are rampant. We won't get paid for the transport either way... I might as well tell the truth and we dont get reimbursed and our company will stop trying to have us transport just for dollar signs, instead of lying on my PCR.

However, decisions to transport based on reimbursement situations needs to enforced at the dispatch or supervisor level and not by individual providers, even if that means that in certain situations crews request a supervisor prior to transport.

Attached to the above post, I've done this, too. However, our supervisors (especially in dispatch) will tell us to transport just for ease of the situation and getting paid. One of my favorites involves having a patient that weighed 650lbs being placed onto my 500lb-rated stretcher, and my supervisor telling me "Just put her on the cot and transport". Long story short, she stayed in the hospital for another night until a bariatric rig came to transport her.

they're making the newbies write "Pt needs ambulance because of...."

I believe I see the point you are trying to make with this, and I agree. While, as Linuss points out, it's okay to write this, I agree that it shouldn't NEED to be written.

I shouldn't have to write my PCR as if I'm filling out some online FWD: survey. "Pt needs an ambulance because _________" A properly completed PCR and good thorough narrative should outline this for you.


Also, as to others ripping on you for the while S3/S4 debate... That's a friendly, gloves-on version of what a lawyer would do to you on a witness stand. If you can't read and defend your PCR and everything written on it forward and backward while blindfolded upsidedown and spinning in circles, any half-way decent lawyer can tear it apart and make it seem like you just finished your Basic class last week.

I wouldn't say "Don't listen to heart sounds". On the contrary, listen to EVERYONE's heart. Yours, your family, your partner, healthy patients. And learn everything about the practice and physiology that you can. Because then when you listen to something that's wrong, you may not be able to say with 100% accuracy "OH CRAP STENOSIS!", but you -can- know enough to know something ain't working right. And you don't have to diagnose a cardiac condition with complete accuracy to impress or get a pat on the back from a Doc.. Sometimes something as simple as "Hey Doc, I did listen to heart sounds and heard something a little weird toward the apex..." will clue the Doctor in and show that you do a thorough assessment without the opportunity to completely embarrass yourself.

 

[gastro18]

Actually, I do. And I get yelled at by management for it. My job is to document the facts, and in my system, bull:censored::censored::censored::censored: private transports are rampant. We won't get paid for the transport either way... I might as well tell the truth and we dont get reimbursed and our company will stop trying to have us transport just for dollar signs, instead of lying on my PCR.




Attached to the above post, I've done this, too. However, our supervisors (especially in dispatch) will tell us to transport just for ease of the situation and getting paid. One of my favorites involves having a patient that weighed 650lbs being placed onto my 500lb-rated stretcher, and my supervisor telling me "Just put her on the cot and transport". Long story short, she stayed in the hospital for another night until a bariatric rig came to transport her.





I believe I see the point you are trying to make with this, and I agree. While, as Linuss points out, it's okay to write this, I agree that it shouldn't NEED to be written.

I shouldn't have to write my PCR as if I'm filling out some online FWD: survey. "Pt needs an ambulance because _________" A properly completed PCR and good thorough narrative should outline this for you.


Also, as to others ripping on you for the while S3/S4 debate... That's a friendly, gloves-on version of what a lawyer would do to you on a witness stand. If you can't read and defend your PCR and everything written on it forward and backward while blindfolded upsidedown and spinning in circles, any half-way decent lawyer can tear it apart and make it seem like you just finished your Basic class last week.

I wouldn't say "Don't listen to heart sounds". On the contrary, listen to EVERYONE's heart. Yours, your family, your partner, healthy patients. And learn everything about the practice and physiology that you can. Because then when you listen to something that's wrong, you may not be able to say with 100% accuracy "OH CRAP STENOSIS!", but you -can- know enough to know something ain't working right. And you don't have to diagnose a cardiac condition with complete accuracy to impress or get a pat on the back from a Doc.. Sometimes something as simple as "Hey Doc, I did listen to heart sounds and heard something a little weird toward the apex..." will clue the Doctor in and show that you do a thorough assessment without the opportunity to completely embarrass yourself.

thanks monekysquasher! you're a true gentleman

 

[Sasha]

Thanks for the reply.

I know what you're saying about companies with contracts. We do have such arrangements with some facilities. I dont really have a problem with that. I go to where dispatch wants me to go. But for the company to impose on EMTs to explicitly state why the patient needs ambulance is somehow "inviting trouble". of course, not all patients are billable under medicare, medical,etc. that's why companies just consider those runs as hit-or-miss runs, or 'marketing expense' to not piss-off the client facility.

Some of these companies make EMTs use these "magic words" (the patient needs an ambulance because ____...) to hustle for a payout, at the expense of the EMT who then needs to explain to a jury why he declared a medical necessity on such a questionable patient.

I say, just write the chief complaint, write the assessments and let billing and paying party decide if that call gets paid or not. Of course, assuming that documentation is accurate and makes sense.

There's really nothing wrong with asking for reasons the call was medically necessary. I've worked for IFT companies that have done the same, I simply write in the blank "Ambulance transport not indicated due to pt not bedconfined, no isolation, no equipment" etc.

 

[gastro18]

There's really nothing wrong with asking for reasons the call was medically necessary. I've worked for IFT companies that have done the same, I simply write in the blank "Ambulance transport not indicated due to pt not bedconfined, no isolation, no equipment" etc.

good one sasha! thank you for your input

 

[Jon]

I'll chime in... a little late, but who cares?


S/R next to a pulse would have to stand for Strong and Regular. Pretty common around here. Perhaps the FTO is a wannabe medic?

NTV? Never heard of it. I do document "respirations of adequate depth and rate" in my exam when there isn't an obvious respiratory problem present.

The transport co. I work at re-did our tripsheets a year or two back. One of the lines says "Reason Pt. Requires Ambulance Transport"

We also have a yearly required training EVERYONE does about Medicare PCS's. If there is an issue, we are to work with Dispatch. We don't complete the "reason for transport" section of the PCS.

 

[gastro18]

thanks for the reply Jon.

Well, I am beginning to accept that S/R is for strong and irregular. I just feel uncomfortable when some of my co-workers think it's "sinus rhythm". I think the best approach to this one is to just stop doing it. Instead, document on the narrative if the pt's pulse is irregular, or weak, or thready, etc., if an abnormal finding is actually assessed. Otherwise, the pulse rate alone would suffice.

As for the NTV, I think it's just totally unnecessary. I can't stop thinking that it's Nigerian TV or NASA TV. For EMT-Bs to be consciously documenting that a pt has "normal tidal volume" is definitely a topic of coffee-break conversation for RTs and pulmonologists. At the very least, these respiratory professionals might end up shrugging their shoulders or scratching their heads. Suppose there's an abnormal finding in the pt's respiratory function, then we document it on the narrative. If it's normal, then let's just write the respiratory rate, with no fancy initials such as NTV after the number.

And yes, I totally advocate not explicitly writing "reason for transport". Documenting an explicit proclamation of ambulance necessity, somehow, potentially puts the provider in the crosshairs of reimbursement disputes. Our field assessments should be the deciding factor whether or not an ambulance provider gets paid or not. And with accurate and honest assessments, then perhaps these efforts should put a halt on unnecessary (or shady) ambulance transports.

 

[JPINFV]

And yes, I totally advocate not explicitly writing "reason for transport". Documenting an explicit proclamation of ambulance necessity, somehow, potentially puts the provider in the crosshairs of reimbursement disputes. Our field assessments should be the deciding factor whether or not an ambulance provider gets paid or not. And with accurate and honest assessments, then perhaps these efforts should put a halt on unnecessary (or shady) ambulance transports.

You do like being paid, correct? Would you give up your pay if you're on a transport that doesn't get reimbursed?

 

[gastro18]

Yes I do like getting paid. The great thing with being an EMT-B here in LA County is I get paid by the hour. I am not involved with profit sharing, nor is my paycheck dependent on my PCRs getting a successful reimbursement on a call. I go about documenting honest assessments, and so far, my company has never called my attention for not writing "reason for ambulance transport". And I have been working there for two years now. I even talk to billing and ask them if my documentation has created a problem for them. All I got was a simple "no". I am fortunate that my company treats me as what I signed up for -- to be an EMT-B. I go where dispatch wants me to go. I do the best I can for patients. When it comes to documentation, they leave me alone. As long as I write an honest one.

I know I have transported pt's (many times) that didn't require an ambulance. But if we don't get paid on those calls, that doesn't get me in trouble, so long as my documentation is honest and accurate. Who gets in trouble? The company marketer who referred the call. Or the dispatcher, who failed to gather as much information about the call, justifying an ambulance ride. My company is quick too when it comes to correcting these cash flow problems. We have fired 6 marketers and around 5 dispatchers in a span of two years. Why? Because my company also likes getting paid.

Now we have hospital contracts too. A lot of times these facilities would abuse our service and my boss would just treat it as "marketing expense". I know he has personally talked to nurse managers in attempts to stop these unnecessary rides, but that I think it is still work in progress. I like getting paid. My company too. But if there's no valid reason why a pt needs an ambulance ride, then I'm not writing anything to support a necessity for transport.

 

[gastro18]

thanks for the reply Jon.

Well, I am beginning to accept that S/R is for strong and irregular.

I meant strong and regular