ED Callbacks

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I am a brand new attending and will have to oversee ED callbacks (by a PA). As a resident I never had to be involved in callbacks so I really don't have any experience. I know most of it should be straightforward, but I anticipate some cases where it will be unclear to the PA and probably myself if the PA has asked me what to do. I'm assuming most cases are for x-ray rereads, and +culture results.

Does anyone have any advice on what to expect? I'll be in a system where most patients have a PMD so I think I can refer a lot of things to the PMD. Any general guidelines/pointers would be appreciated

Most callbacks aren't QA stuff. There is this stupid thing called the Studer initiative that shows people give better satisfaction scores if they're called. So basically they're calling to ask how things are going, can we offer you better sandwiches next time, etc.
QA is something else typically.
Either way, it's usually not anything that concerning.

I thought it was for abnormal results- say someones GC probe comes back positive, or a radiologist detects a fracture that you missed. Or a blood culture is positive? Stuff like that?

what exactly you have to do depends on your group, so ask your director.

when in doubt, have the patient come back or see their PMD. most of the stuff will be VERY straightforward and won't require your involvement at all.

you have to be very very careful what you tell some patients on the phone - like i said, when in doubt, have them return, especially for STD's.

when i was really crook i got a call every day from the neuro dept, pain management and ED! because i was living by myself they wanted to make sure i was ok...now i do these calls not only to give crappy news but just to see how a patient is doing....i make them quick so the d/c patient can't distract me from my work

We did these in residency. Sometime's they're patient satisfaction, but mostly it's:

- A question about their discharge instructions
- A question about their discharge prescriptions.
- Concern about ongoing symptoms since discharge
- Test results, such as infectious disease panels (lyme), etc. NB: for abnormal GC/Chlamydia, etc, we had a RN calling them.
- Often enough, a request for opiods because the discharging physician didn't provide them. I never, ever did this, instead asked them to fu with their PCP or return to the ED for evaluation.
- Very rarely a complaint.

Overall, if your system has an EMR then this process isn't too bad. If in doubt, I always told pts to come back to our or their ED of choice for re-evaluation.

Originally Posted by BushDoc20

when i was really crook i got a call every day from the neuro dept, pain management and ED! because i was living by myself they wanted to make sure i was ok...now i do these calls not only to give crappy news but just to see how a patient is doing....i make them quick so the d/c patient can't distract me from my work

What does really crook mean?

Originally Posted by Jarabacoa

What does really crook mean?

per my google search, it's Australian slang for sick

I'm a PA in the ER and we have callbacks to do all the time. We don't have a radiologist on overnights, so we wet read all of our x-rays. So sometimes we miss a subtle fx and will have to call back a Pt to come back in a get a splint etc. Typically they are stress free and just a little annoying. I've heard of institutions calling pts for quality control type stuff, like how would you rate your stay blah blah. Hope this helps!

Matt