More Beaumont drama

[deleted126335]

Starkman: Beaumont Nurse Anesthetists at Royal Oak, Troy and Grosse Pointe Vote Overwhelmingly to Unionize

www.deadlinedetroit.com

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[Shimmy8]

Weird article, especially the little jab at the end.

Also funny that they would have joined a “nurses” union while Michigan approves independent practice...

 

[nimbus]

Eric Starkman is a dog with a bone. Beaumont should put him on their payroll to stop writing about them.

 

[IlDestriero]

Sure. Makes sense. Totally. She was asked to provide back up coverage for some part of the hospital and it was totally reasonable and even expected she would access the records of a patient that had a bad outcome there 2 months earlier. Probably pending litigation as well. How f’ing dumb are you. Omg.
I’d get suspended and let go for that as well.
Were they waiting for her to slip up? Who knows. She suicided her own career. Twice.

 

[deleted126335]

Sure. Makes sense. Totally. She was asked to provide back up coverage for some part of the hospital and it was totally reasonable and even expected she would access the records of a patient that had a bad outcome there 2 months earlier. Probably pending litigation as well. How f’ing dumb are you. Omg.
I’d get suspended and let go for that as well.
Were they waiting for her to slip up? Who knows. She suicided her own career. Twice.

The "explanation" for accessing the medical record is total BS. It is the selective enforcement and timing that her attorney will make an issue of. If she wasn't a PITA, would anybody including her bosses have cared or looked? IDK, but I have my doubts. Don't know if that matters legally or not. Really got the schadenfreude for Northstar and Beaumont admin though.

 

[IlDestriero]

I’m on the QI team and I wouldn’t even look sideways in the direction of that record without an admin telling me to do it. Unless I cared for them for another procedure. That’s fair game and probably necessary to make sure you don’t repeat it.
I’m not sure a lot of folks went snooping in that record, so I’m not convinced it’s selective enforcement. Easy enough to determine with an EMR.

 

[anbuitachi]

they should all quit. see what northstar does. but pretty sad someone died during routine colonoscopy soon after northstar takeover.

but i hear otherwise beaumont is doing pretty well after the handover to northstar

 

[Man o War]

How can someone be this stupid

 

[deleted126335]

....

I’m not sure a lot of folks went snooping in that record, so I’m not convinced it’s selective enforcement. Easy enough to determine with an EMR.

I wasn’t talking about this particular record, but I would bet decent money that people check out anesthetic records all the time of patients whose care that they are not involved in if for no other reason than to find out how close rooms are to finishing and then getting relief . How hard does any institution go looking for stuff like that and disciplining (or not disciplining)people is what I meant regarding selective enforcement.

 

[Man o War]

Weird article, especially the little jab at the end.

Also funny that they would have joined a “nurses” union while Michigan approves independent practice...

One of their wish list items is guaranteed breaks.

 

[nimbus]

I wasn’t talking about this particular record, but I would bet decent money that people check out anesthetic records all the time of patients whose care that they are not involved in if for no other reason than to find out how close rooms are to finishing and then getting relief . How hard does any institution go looking for stuff like that and disciplining (or not disciplining)people is what I meant regarding selective enforcement.

We pick our own schedules for the next day. We review charts before picking cases all the time and have been told that’s a legitimate use even though we don’t end up involved in their care.

 

[GassYous]

I look at charts to see how other people run their anesthetics all the time. It really helps me develop my practice without actually doing 10,000 cases a year.

 

[narcotics999]

I wasn’t talking about this particular record, but I would bet decent money that people check out anesthetic records all the time of patients whose care that they are not involved in if for no other reason than to find out how close rooms are to finishing and then getting relief . How hard does any institution go looking for stuff like that and disciplining (or not disciplining)people is what I meant regarding selective enforcement

Just don't touch the charts related to "person of interest". Bad outcome, VIPs....

 

[coffeebythelake]

Just don't touch the charts related to "person of interest". Bad outcome, VIPs....

I review records of patients to see how they do after surgery. My patients. Not other people's patients.

 

[coffeebythelake]

I look at charts to see how other people run their anesthetics all the time. It really helps me develop my practice without actually doing 10,000 cases a year.

I would caution you against doing that. It might get you in trouble one day. Ask a colleague instead.

 

[robellis]

I would caution you against doing that. It might get you in trouble one day. Ask a colleague instead.

I look at other charts all the time as well for education, why wouldn’t I? Education is one of the exemptions for looking at charts

 

[chocomorsel]

I look at charts to see how other people run their anesthetics all the time. It really helps me develop my practice without actually doing 10,000 cases a year.

I never really knew this was a thing until a few months ago by reading it on here. Never occurred to me.

 

[coffeebythelake]

I look at other charts all the time as well for education, why wouldn’t I? Education is one of the exemptions for looking at charts

Ok, don't say you haven't been warned.

 

[Leinie]

Ok, don't say you haven't been warned.

As I get further into practice I no longer do a number of things I used to do all the time. This seems like another good place to exercise increased caution, especially given the example above.

Leinie

 

[GassYous]

As I get further into practice I no longer do a number of things I used to do all the time. This seems like another good place to exercise increased caution, especially given the example above.

Leinie

Like what

 

[Zekchar]

Like what

Like if you're not involved in a patient's care, you don't look in their chart. Not worth the headache or drama.

 

[anbuitachi]

most of us here look at charts , especially when running the OR, seeing which cases are close to finishing etc. education sometimes as well

 

[coffeebythelake]

most of us here look at charts , especially when running the OR, seeing which cases are close to finishing etc. education sometimes as well

Not saying what people do.
Saying what is appropriate and does not violate hipaa.
You looking in a random person's chart without a suitable reason is a hipaa violation.
"Education" is very loose and arguably not a reason for accessing a random person's chart.

 

[anbuitachi]

Not saying what people do.
Saying what is appropriate and does not violate hipaa.
You looking in a random person's chart without a suitable reason is a hipaa violation.
"Education" is very loose and arguably not a reason for accessing a random person's chart.

isnt hipaa already violated when they post the next days schedule with patient MRN and name for EVERY OR and you go down the list to see where you are?

 

[coffeebythelake]

isnt hipaa already violated when they post the next days schedule with patient MRN and name for EVERY OR and you go down the list to see where you are?

So what you are saying is that because there is a surgical schedule with patient identifiers, that gives you the right to systematically go through everyone's chart as you please. SMH. Wrong.

 

[GassYous]

So what you are saying is that because there is a surgical schedule with patient identifiers, that gives you the right to systematically go through everyone's chart as you please. SMH. Wrong.

I don't go through the chart, just look at the anes record. There's almost no information about the patient in there, just the medications given and such.

 

[anbuitachi]

So what you are saying is that because there is a surgical schedule with patient identifiers, that gives you the right to systematically go through everyone's chart as you please. SMH. Wrong.

pretty sure i said no such thing. just saying if you dont look at anes record bc of hipaa, do you also not look at next days schedule.. bc of hipaa?

 

[coffeebythelake]

I don't go through the chart, just look at the anes record. There's almost no information about the patient in there, just the medications given and such.

That really depends on what system you use. Many EMRs clearly list past medical history, allergies, substance use history (alcohol, tobacco, illicit drugs), medications, and other details in yhr anesthesia chart. Stuff that patients want to keep away from your snooping eyes.

 

[anbuitachi]

That really depends on what system you use. Many EMRs clearly list past medical history, allergies, medications, and other details in yhr anesthesia chart.

nothing will get done in many practices if every rule is followed to the dot.

one example is, on the anesthesia consent , you write the anesthesiologists name that the patient is consenting to to provide anesthesia. so i guess the question then becomes.. what happens when another anesthesiologist relieves the person who obtained the consent, during the middle of a case. the patient never consented for 2nd anesthesiologist to do the anesthesia. imagine if a different surgeon relieves the original surgeon midway even though his/her name not on the consent, i can see that being a problem. at one point we tried to write name of our practice on the consent form for providing anesthesia.. but risk management said we cant do that =\

 

[coffeebythelake]

pretty sure i said no such thing. just saying if you dont look at anes record bc of hipaa, do you also not look at next days schedule.. bc of hipaa?

What do you think has more protected health information in it? I don't believe I have to argue with you that going into someone's chart without a valid reason is a potential actionable reason for your employment to be terminated.

You want to know when the case is finishing?? How about some good old fashion communication with words? What ever happened to just talking to the anesthesia staff in the room? Many EMR tracking boards today have color coded for preop, in room, closing, out of room. I take 1st call and coordinate ORs and I don't go snooping in people's charts if thry are not my patients

 

[coffeebythelake]

nothing will get done in many practices if every rule is followed to the dot.

one example is, on the anesthesia consent , you write the anesthesiologists name that the patient is consenting to to provide anesthesia. so i guess the question then becomes.. what happens when another anesthesiologist relieves the person who obtained the consent, during the middle of a case. the patient never consented for 2nd anesthesiologist to do the anesthesia. imagine if a different surgeon relieves the original surgeon midway even though his/her name not on the consent, i can see that being a problem. at one point we tried to write name of our practice on the consent form for providing anesthesia.. but risk management said we cant do that =\

Read the verbiage on the anesthesia consent. It allows for other providers to be involved as necessary to take care of the patient. And if your anesthesia consents do not say something along those lines you should talk to your hospital legal department about changing it to be more precise.

 

[anbuitachi]

What do you think has more protected health information in it? I don't believe I have to argue with you that going into someone's chart without a valid reason is a potential actionable reason for your employment to be terminated.

You want to know when the case is finishing?? How about some good old fashion communication with words? What ever happened to just talking to the anesthesia staff in the room? Many EMR tracking boards today have color coded for preop, in room, closing, out of room. I take 1st call and coordinate ORs and I don't go snooping in people's charts if thry are not my patients

your argument is because one has MORE protected info in it it's not okay, but one has LESS but still has PHI, it is okay? i'm pretty sure that's not how HIPAA works. I never said another persons chart doesnt have more info than other stuff with PHI, but i'm pretty sure it's either you break HIPAA or not, not how much PHI you have to review

work place can easily just send you YOUR assignment with the patients info. but ive never been in a practice that did this.

Also many EMRs have tracking boards and the tracking boards usually also has name, mrn, procedure, etc.

 

[coffeebythelake]

your argument is because one has MORE protected info in it it's not okay, but one has LESS but still has PHI, it is okay? i'm pretty sure that's not how HIPAA works. I never said another persons chart doesnt have more info than other stuff with PHI, but i'm pretty sure it's either you break HIPAA or not, not how much PHI you have to review

That is actually how HIPAA works. You are only privy to the necessary amount of health protected information to get your job done. The OR schedule is not available to everyone. In public view screens do not show HIPAA protected PHI. If you are in the OR pool you have access to basic patient identifiers (e.g., name and dob) and basic PHI (e.g. the surgical procedure), because you only need to know basic information and you should not have any additional access to detailed patient information. If you open the chart you are attesting that you have the right to access the detailed information. People have been fired for inappropriately accessing charts of patients.

Interpreting your reasons for accessing this data and whether your hospital takes a hard line stance against in enforcing this is a separate matter, like whether you will get a ticket when you speed 70 mph in a 65 mph zone.

 

[anbuitachi]

That is actually how HIPAA works. You are only privy to the necessary amount of health protected information to get your job done. The OR schedule is not available to everyone. In public view screens do not show HIPAA protected PHI. If you are in the OR pool you have access to basic patient identifiers (e.g., name and dob) and basic PHI (e.g. the surgical procedure), because you only need to know basic information and you should not have any additional access to detailed patient information. If you open the chart you are attesting that you have the right to access the detailed information. People have been fired for inappropriately accessing charts of patients.

Interpreting your reasons for accessing this foolishness and whether your hospital takes a hard line stance against in enforcing this is a separate matter, like whether you will get a ticket when you speed 70 mph in a 65 mph zone.

Oh i guess our hospitals work differently. our entire anesthesiology department can see the entire OR schedules. And i would argue other anesthesiologists do not need to know which patient and what case you are doing for you to get your job done.

 

[Arch Guillotti]

most of us here look at charts , especially when running the OR, seeing which cases are close to finishing etc. education sometimes as well

I don't know why you would need to look at the chart though. Information can be gleaned some other way.

 

[Arch Guillotti]

If you open the chart you are attesting that you have the right to access the detailed information. People have been fired for inappropriately accessing charts of patients.

This.

 

[agolden1]

That is actually how HIPAA works. You are only privy to the necessary amount of health protected information to get your job done. The OR schedule is not available to everyone. In public view screens do not show HIPAA protected PHI. If you are in the OR pool you have access to basic patient identifiers (e.g., name and dob) and basic PHI (e.g. the surgical procedure), because you only need to know basic information and you should not have any additional access to detailed patient information. If you open the chart you are attesting that you have the right to access the detailed information. People have been fired for inappropriately accessing charts of patients.

Interpreting your reasons for accessing this foolishness and whether your hospital takes a hard line stance against in enforcing this is a separate matter, like whether you will get a ticket when you speed 70 mph in a 65 mph zone.

Have worked within three different hospital systems. The hospital I'm at now doesn't seem to care at all. As a result, there is a fairly lax culture when it comes to reviewing other patient's charts without reason, looking up how to do certain cases, surgeons taking images of things with their cell phones, texting of info, looking at their own personal health file, etc.

Where I was before, the hospital had built a pretty severe culture around these kinds of lapses. There were routine chart audits to see who had been looking at charts. If you were some place you weren't supposed to be, you were out. Happened to some nurses while I was there. Take picture of anything related to patient care on your phone and were seen? One warning, then fired for repeat offense. Happened to a surgeon. Open your own file to follow up on that CBC you had drawn? One warning, then fired for repeat offense. There are nursing and PA forums littered with HIPAA violation horror stories. I just don't want to be one of them, so I'll stick to just the cases I'm involved in.

 

[robellis]

Yah it seems to be hospital dependent, education is a very good reason to access charts imo, I’m not sure why we wouldn’t want our doctors to get better at treating patients by looking at charts, obviously you shouldn’t be snooping around and only looking at very specific educational things in the chart

 

[deleted126335]

One of their wish list items is guaranteed breaks.

Mine too. Along with work less. Make more. More rights. Less responsibilities. A unicorn would be nice too.

 

[coffeebythelake]

Yah it seems to be hospital dependent, education is a very good reason to access charts imo, I’m not sure why we wouldn’t want our doctors to get better at treating patients by looking at charts, obviously you shouldn’t be snooping around and only looking at very specific educational things in the chart

If you want to learn for your education then you talk to the anesthesiologist who did the case and maybe they will open the chart and run it through with you. Don't go about doing it sneakily. This is how we do grand rounds and m&ms. Someone actually involved in the case curates the chart and scrubs the HPI when they present it for education.

 

[chocomorsel]

If you want to learn for your education then you talk to the anesthesiologist who did the case and maybe they will open the chart and run it through with you. Don't go about doing it sneakily. This is how we do grand rounds and m&ms. Someone actually involved in the case curates the chart and scrubs the HPI when they present it for education.

Admittedly I have been out of Academics for a while but I thought HPIs were part of an M&M presentation. Otherwise how do you know how to prepare a case without a Hx?

 

[PainDrain]

Have worked within three different hospital systems. The hospital I'm at now doesn't seem to care at all. As a result, there is a fairly lax culture when it comes to reviewing other patient's charts without reason, looking up how to do certain cases, surgeons taking images of things with their cell phones, texting of info, looking at their own personal health file, etc.

Where I was before, the hospital had built a pretty severe culture around these kinds of lapses. There were routine chart audits to see who had been looking at charts. If you were some place you weren't supposed to be, you were out. Happened to some nurses while I was there. Take picture of anything related to patient care on your phone and were seen? One warning, then fired for repeat offense. Happened to a surgeon. Open your own file to follow up on that CBC you had drawn? One warning, then fired for repeat offense. There are nursing and PA forums littered with HIPAA violation horror stories. I just don't want to be one of them, so I'll stick to just the cases I'm involved in.

If you are responsible for making schedules or running OR assignments a system that takes a hard line against opening charts is going to get you in trouble. If I am trying to decide who does a certain case I open the chart and review complexity of the patient and the case. It may appear from the outside that I am snooping but in reality I am trying to coordinate that patient’s care.

Now, reviewing the chart of someone weeks after an event in which you were not involved is obviously a violation of big no no.

 

[Southpaw]

If you are responsible for making schedules or running OR assignments a system that takes a hard line against opening charts is going to get you in trouble. If I am trying to decide who does a certain case I open the chart and review complexity of the patient and the case. It may appear from the outside that I am snooping but in reality I am trying to coordinate that patient’s care.

Now, reviewing the chart of someone weeks after an event in which you were not involved is obviously a violation of big no no.

Maybe. On the other hand, if you're responsible for looking in patient's charts and delegating cases based on acuity/patient complexity then that's dumb and that job sucks. If it's a heart, give it to the heart guy. If it's a kid, give it to someone comfortable with kids. So on and so on. No one absolutely needs to go looking in charts to make out a schedule. That's nuts.

 

[chocomorsel]

Maybe. On the other hand, if you're responsible for looking in patient's charts and delegating cases based on acuity/patient complexity then that's dumb and that job sucks. If it's a heart, give it to the heart guy. If it's a kid, give it to someone comfortable with kids. So on and so on. No one absolutely needs to go looking in charts to make out a schedule. That's nuts.

Maybe he’s talking of deciding which midlevel to give the case. And working to their strengths and weaknesses.

 

[nimbus]

Maybe. On the other hand, if you're responsible for looking in patient's charts and delegating cases based on acuity/patient complexity then that's dumb and that job sucks. If it's a heart, give it to the heart guy. If it's a kid, give it to someone comfortable with kids. So on and so on. No one absolutely needs to go looking in charts to make out a schedule. That's nuts.

What if you pick your own cases and don’t really want a 60BMI patient with 15% EF?

 

[nimbus]

Have worked within three different hospital systems. The hospital I'm at now doesn't seem to care at all. As a result, there is a fairly lax culture when it comes to reviewing other patient's charts without reason, looking up how to do certain cases, surgeons taking images of things with their cell phones, texting of info, looking at their own personal health file, etc.

Where I was before, the hospital had built a pretty severe culture around these kinds of lapses. There were routine chart audits to see who had been looking at charts. If you were some place you weren't supposed to be, you were out. Happened to some nurses while I was there. Take picture of anything related to patient care on your phone and were seen? One warning, then fired for repeat offense. Happened to a surgeon. Open your own file to follow up on that CBC you had drawn? One warning, then fired for repeat offense. There are nursing and PA forums littered with HIPAA violation horror stories. I just don't want to be one of them, so I'll stick to just the cases I'm involved in.

I guess this thread wouldn’t fly at some places.

Let's do some echo:

Let's do some basic Echo: This comes from my personal data base, so I hope you guys dig it. Med studs and residents first. Name 1-7

forums.studentdoctor.net

 

[PainDrain]

Maybe. On the other hand, if you're responsible for looking in patient's charts and delegating cases based on acuity/patient complexity then that's dumb and that job sucks. If it's a heart, give it to the heart guy. If it's a kid, give it to someone comfortable with kids. So on and so on. No one absolutely needs to go looking in charts to make out a schedule. That's nuts.

It may seem “dumb” when managing just a handful of providers but it is something that is required when managing hundreds of cases per day in a large practice.

 

[coffeebythelake]

Admittedly I have been out of Academics for a while but I thought HPIs were part of an M&M presentation. Otherwise how do you know how to prepare a case without a Hx?

To clarify my previous post.. It's only an issue if it include patient identifiers or enough unique HPI (some extremely oddball hiatory) to allow someone to reasonably infer who the patient is. When you scrub patient identifiers it is anonymized. This is what happens with M&M conferences and also what happens when they take data to use in research and publications

 

[coffeebythelake]

What if you pick your own cases and don’t really want a 60BMI patient with 15% EF?

Then u turf it to the young guy

 

[deleted162650]

What if you pick your own cases and don’t really want a 60BMI patient with 15% EF?

Hmmm. Didn’t we recently have a discussion about old guys not wanting to do tough cases??