To help prevent problems with a missed or delayed diagnosis, work with the radiology and diagnostic test departments in your facility to establish clear protocols for ensuring timely results.
This can include establishing criteria for information to be provided to the radiologist to assist with interpretation, addressing the notification process, and developing a process for monitoring discrepancies between the emergency medicine department (EMD) and radiology readings.
Implement a formal plan that outlines the circumstances under which an EMD physician should contact the patient’s care provider or the patient to change the course of treatment in the event of significant discrepancies. Create a follow-up system for cultures completed after the patient’s discharge. All communications with patients and other providers should be documented in the medical record.
Establish protocols to ensure that the patient’s primary care provider and involved specialists routinely receive information regarding the patient’s care and treatment and any follow-up instructions after the EMD visit. The EMD physician should call the patient’s care provider personally when there is pertinent information to communicate and when the patient requires additional follow-up care. EMD physicians should also request early consultation for patients in need of such services. For example, seek the involvement of cardiology for acute myocardial infarction and orthopedics for open fractures.
Make sure EMD staff and physicians are aware of ancillary services that are available to help ensure a safe discharge or transition in care for patients presenting to the department. Updated information on ancillary services, such as ombudsmen, social services, clergy, psychiatric services, pharmacists, case managers, and financial advisors should be readily available and easily accessible for all EMD staff.
Healthcare facilities that are unable to accommodate morbidly obese patients in their diagnostic imaging suite or if MRIs or CTs are not available at night or on weekends should have transfer agreements in place with open facilities so there are no delays in urgent images or scans. Educating physicians and staff on the availability and appropriate use of ancillary services can promote safe discharges and prevent readmissions.
Many patients return to the EMD within 24 hours of being discharged due to unresolved medical problems, inadequate discharge instructions, or poor post-discharge planning.
Some of these visits can be avoided if the EMD implements a call-back program. The EMD can have a nurse, physician assistant, or physician contact patients within 24 hours of discharge. The protocol can involve contact with every patient or only those meeting specific criteria, such as the frail elderly, poorly compliant patients, and those requiring additional follow-up care due to complex medical conditions.
Calling a patient after a visit to the EMD can help detect a potential problem, improve compliance, and improve patient satisfaction. Patients are usually surprised and then appreciative to receive this type of care and attention. Initiating patient satisfaction surveys can also help identify key areas for quality improvement and further bolster patient satisfaction.
To improve patient compliance and prevent readmissions, provide patients and their families with clear and specific discharge instructions. All patients should be given both oral and written discharge instructions before they leave the EMD.
The discharge instructions should be a team effort between the EMD physician, nurse, and other disciplines involved in the patient’s care. Instructions should include the time frame for recommended follow-up, discharge medications, and any condition-specific recommendations. In addition, providers should ensure adequate understanding of the information by providing a translator as needed or asking patients to repeat back and demonstrate what they have learned.
By Sonny Nguyen, Senior Director, Patient Safety and Risk Management, Northwest Region.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.