Do you ever wish you could follow an interesting case?

What I've found so far (I'm only a resident) is that if there's a patient I'm interested in down in the ED, my curiosity is well sated by following their electronic medical records after admission. I don't feel the need to actually be involved in their day-to-day work-up and treatment. I think that would be tedious, especially for those patients that are inpatient for weeks or months. But checking in once a week on the computer lets me know if I got the ball going on the right track in the ED, what things I maybe should have done differently, and the patient's well-being (or lack thereof).

Does HIPPA impact following up on an ED patient? I would think that once you admit and transfer care, you're no longer considered part of the treatment team and thus not technically allowed to access the record...

DeadCactus said:

Does HIPPA impact following up on an ED patient? I would think that once you admit and transfer care, you're no longer considered part of the treatment team and thus not technically allowed to access the record...

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Don't know for sure, but I seriously doubt it. You were the person's doctor, after all (maybe different if you transfer them to another facility).

And sorry to be a pedant here, but the abbreviation is HIPAA. It stands for Health Insurance Portability and Accountability Act (pet peeve of mine).

I follow the interesting patients I see in the ED that I admit through EMR or asking my colleagues. I do occasionally wonder what happened to a patient I had to transfer (especially the out-of-network peds cases), but I don't feel crushing disappointment about lack of follow-up. If I really want to know what happens to someone I discharged then I call them.

Jarabacoa said:

No, and no.

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Seconded.

RustedFox said:

Seconded.

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Thirded....

I much prefer getting the end story a few days later from the EMR.

I have... But here in LV I am just gonna give up because good cases are wasted on piss poor inpatient care...
This is probably true at all community places...
Admit a potentially very interesting case and no matter what, the name of the game is simply to get some imaging, fix abnormal labs and discharge to home/rehab. Making ability to follow tests/consults/rtc on the EMR impossible.



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Our EMR has mostly dictations, so for H&P, discharge summaries and consults there is complete prose available to read, which makes following up on patients easy.

I typically follow up on all critically ill, interesting, or the rare nice patient that I see. In general it's QI for myself to see what I missed, what I could have done differently and what I did right.

Our EMR makes it easy to follow up on patients. We have a patient list that automatically populates with patients still in the hospital that we placed any order on. So as long as they are still in the hospital, that list will keep a tab of my patients (usually 15-30 patients long). I follow up on a lot of my patients just because its easy. I can quickly find out if a chest pain ruled in or if a bad COPDer ended up getting intubated.

Our institution also gives limited access to physicians that refer a large number of people to our hospital (ER docs, family docs, hospitalists, intensivists, etc) at other hospitals to the same EMR so that they can follow up on their patients.

I think it's incredibly beneficial because it provides a little QA as to my workup as well as my initial diagnosis. I don't typically go to their room and actually see them just because it is so far out of the way and would inevitably take 20 or 30 minutes once the family began talking to me.

EM_Rebuilder said:

Thirded....

I much prefer getting the end story a few days later from the EMR.

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I'll admit I am an - apparent - outlier here.

I do wish I could manage critical care patients for a longer period of time -- but then again, I will likely be starting a CCM fellowship in the near future.

However, like the others have said above - I have no interest in following the typical patient beyond the ED...except for EMR checks for both interest and "QA"/education.

HH