CP r/o MI

[FutureDocDuffy]

In the emergency department I work in as an ER tech if a patient comes in for example flank pain or back pain they get the normal uti/stone work but sometimes attending or midlevel admits the patient as a chest pain obs even though the ROS states CV: Negative for chest pain, negative for shortness of breath and what not. I was curious if that is possible or am I just missing something or did any red flags possibly get set off. I've never had the stones to actually ask the doc. and I was wondering how insurance companies interpret this?

---

Members don't see this ad.

 

[pianoman511]

In the emergency department I work in as an ER tech if a patient comes in for example flank pain or back pain they get the normal uti/stone work but sometimes attending or midlevel admits the patient as a chest pain obs even though the ROS states CV: Negative for chest pain, negative for shortness of breath and what not. I was curious if that is possible or am I just missing something or did any red flags possibly get set off. I've never had the stones to actually ask the doc. and I was wondering how insurance companies interpret this?

Back/flank pain may present as an anginal equivalent meaning that it could be worse with exertion/better with rest. It may also be known as atypical pain. There are a great many things that present as back or flank pain besides urinary pathology. The more concerning ones include things like MI, PE, thoracic or abdominal aneurysm or dissection, etc. Your HPI or A/P will be the place to look to see a provider's rationale behind making someone an obs candidate. Someone comes in with crescendo/decrescendo back pain which worsens with exertion and has risk factors (CAD, smoker, etc) would likely get a pretty extensive workup.

Many times the chief complaint isn't really indicative of the true problem, which can be the other issue. Sometimes people come in for something seemingly minor or straight forward and during the H&P more concerning symptoms show up which may prompt a workup in a completely different direction. This may be especially important in the case of people who "never go to a doc".

 

[USCDiver]

Also, ROS is a sucky place to look for things the patient actually complained about. There are a lot of times a boilerplate negative ROS gets pasted into a chart and not edited for that specific patient. Look at the HPI, PE and MDI sections if you really want to know what's going on.

 

[TrumpetDoc]

Also, ROS is a sucky place to look for things the patient actually complained about. There are a lot of times a boilerplate negative ROS gets pasted into a chart and not edited for that specific patient. Look at the HPI, PE and MDI sections if you really want to know what's going on.

+1.

If it matters it's in the HPI and/or MDM.

ROS is there cuz I "have to" document it.