Where in the world are the EMS run sheets?

[beanbean]

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Before the advent of electronic run forms, the EMS crews would leave their hand written run forms in the patient chart before leaving the ED. However, since everyone has transitioned to lap tops and electronic records we often do not get any prehospital records while the patient is in the department. Sometimes they aren't faxed until the next day. Therefore, I often don't have info on what meds or interventions a patient may have received, initial patient presentation and other collateral information from the scene. We sometimes call to get copies faxed, but this is a waste of everyone's time. I actually had a dispatcher tell me they couldn't fax the patient record to the ED because it was a HIPAA violation. Hello! Someone needs a PHI refresher!

So, do any of you have the same issue? Any suggestions?

 

[willow18]

I was similarly frustrated during my EM rotation, but the company here usually gets them faxed within an hour or so. Of course, then it sits at the fax machine until someone decides to file them in the proper 'baskets'.

In general I find the 5-page electronic printouts much harder to decipher than the old, single run sheet. Despite the handwriting problem, the narrative the providers wrote gave a better picture than all these little checkboxes. Regardless, they should redesign the printout into one, max two sheets instead of this large packet of uselessness.

 

[deleted65604]

Like our documentation, their documentation is largely a waste. I try to talk to the paramedics directly most the time. If there is a question I have, I can always call them. 15 seconds face to face is better than 2 minutes of trying to understand their chart.

 

[Dwindlin]

Like our documentation, their documentation is largely a waste. I try to talk to the paramedics directly most the time. If there is a question I have, I can always call them. 15 seconds face to face is better than 2 minutes of trying to understand their chart.

On most patients the docs I worked with would try to do this as often as possible.

 

[Arcan57]

It's ironic that the more sheets of paper come with a patient, the less information is conveyed. I had a patient come in with a one page progress note from his doc's office that conveyed PMHx, doppler U/S results, and current INR. I've had 10 page ED charts from transfers on which I could not determine a: chief complaint, pertinent physical exam findings, radiology read of contrast CT scan (no CD attached), or medications give. However, I was damn certain that the patient had his call light within reach (documented 3+ times) and that I was the accepting physician.

 

[jbar]

"Outside hospital, we'll send the nursing notes"

 

[deleted65604]

This recently came to bear in a patien M&M that we had at our facility. 90 year old demented lady was at physical therapy by home-health nurse for chronic neck and back pain and was sent in by the nurse via ambulance. The ambulance run sheets had a lot of information, but no specific complaints of chest pain anywhere. By the time the patient reached the ER, she had no real complaints, except for her chronic pain. History was probably compromised because of dementia. Seen by a nurse practitioner, who did some x-rays of the joints that the patient was complaining of pain in and sent her home.

Patient died 2 days later. The Home Health agency is run by a non-medical person and a litigious nurse (Sued our hospital a few years ago and is now on our Board of Trustees). This Home Health agency reported us to JCAHO, and we got officially investigated for a sentinel event. JCAHO ended up clearing us because there was no evidence of chest-pain complaints on the run-sheet, but the provider hadn't read the report. The home health nurse told JCAHO that she thought the patient was having a heart attack, and she claims she told the paramedics this.

There are multiple issues here:
1. You need to know for a fact exactly why the patient is in the ER. (Who sent them, and why)
2. The fact that a 90 year old demented patient dies, presumably from a heart attack, is unacceptable in this country.
3. The biggest sentinel event here is that the home-health nurse has a concern for the patient and just calls 911, rather than call ahead about her concerns. This lack of ownership of the patient is atrocious and this home-health agency should lose their license to practice, especially if they are going to try to destroy the hospital.
4. Don't even get me started on our hospital board having two people who have previously sued the hospital and one who has been hired and fired twice by the hospital.

 

[deleted65604]

Moral of the story: If you are ever confused about exactly why somebody was sent to the ER, you need to talk directly to the person who sent them, or you will get stabbed in the back by them if they percieve you miss something.

 

[SoCuteMD]

This recently came to bear in a patien M&M that we had at our facility. 90 year old demented lady was at physical therapy by home-health nurse for chronic neck and back pain and was sent in by the nurse via ambulance. The ambulance run sheets had a lot of information, but no specific complaints of chest pain anywhere. By the time the patient reached the ER, she had no real complaints, except for her chronic pain. History was probably compromised because of dementia. Seen by a nurse practitioner, who did some x-rays of the joints that the patient was complaining of pain in and sent her home.

Patient died 2 days later. The Home Health agency is run by a non-medical person and a litigious nurse (Sued our hospital a few years ago and is now on our Board of Trustees). This Home Health agency reported us to JCAHO, and we got officially investigated for a sentinel event. JCAHO ended up clearing us because there was no evidence of chest-pain complaints on the run-sheet, but the provider hadn't read the report. The home health nurse told JCAHO that she thought the patient was having a heart attack, and she claims she told the paramedics this.

There are multiple issues here:
1. You need to know for a fact exactly why the patient is in the ER. (Who sent them, and why)
2. The fact that a 90 year old demented patient dies, presumably from a heart attack, is unacceptable in this country.
3. The biggest sentinel event here is that the home-health nurse has a concern for the patient and just calls 911, rather than call ahead about her concerns. This lack of ownership of the patient is atrocious and this home-health agency should lose their license to practice, especially if they are going to try to destroy the hospital.
4. Don't even get me started on our hospital board having two people who have previously sued the hospital and one who has been hired and fired twice by the hospital.

Call me a pain in the ass, but sometimes when I get a patient who presents like the above, I call the facility or agency and insist that I speak directly with the person who sent them in no matter the hour. Once or twice I've actually saved my (and possibly my attending's) butt this way.

I've had 2 or 3 end-stage, metastatic ca with mets to the brain, DNR/DNI patients sent in by nursing homes for new neurologic findings. Them, "We wondered if she might be having a stroke." Inside I think, "Well, she might be, but I don't know what you think I'm going to do about it."

 

[deleted65604]

I wholeheartedly agree. I try to always call on demented patients who can't give me a good history. Third-hand information is ALWAYS bad, especially with medical history as subtle details can make a world of difference.

 

[Arcan57]

I had a near miss the otherday because of that. Demented NH dweller came in with chest pain while eating. Vitals normal, pt. denies pain now, EKG and first set of markers negative. Call the pt's PCP who says he was told the patient desaturated to 80% during said episode. CTPE had bilateral PE's. If they though it was important enough to include in the report to the doctor to authorize having the patient sent to the ED, you'd think they'd want to communicate that to the ED as well.

 

[beanbean]

The going rate of W10 forms and MARs from a nursing home containing useful and accurate information is about 50%. I had an MAR recently that seemed to just have occasional and random initializations signing off meds as administered. The patient had advanced dementia and was on about 15 meds including things like coumadin and antiparkinsons meds that you might want to give as directed. Big surprise, was sent in for altered mental status! I called the home and they could verify when, if ever, he had gotten any meds. I informed his wife and we filed an elder abuse report with the state.

Part of the issue with not getting the EMS report is that it can be hard to track down the crew after they leave the hospital. Getting a verbal report is not usually a problem for serious medical and trauma patients as they present directly to the MD upon arrival. It is those not quite as sick patients that maybe or maybe not got steroids etc. that I would like some sort of sign off about what interventions were given.

 

[Siggy]

Any suggestions?

Anyway you could get coordinate with the local ambulance companies and get the hospital to splurge for a printer that the crews can use? I recommend the hospital since I have serious doubts about most ambulance companies outfitting their ambulances with them or the average EMT-B/P being able to take care of a laptop printer on an ambulance for any length of time.

 

[beanbean]

There is a place for them to print the forms. The problem is they leave without completing their documentation and then fax it later...often in batches. Occasionally a crew will let us know they are having software problems and there will be a delay in getting the report, but most of the time faxing them 24 hours later is just the norm.

 

[Siggy]

^
That's more of an internal culture and procedure issue then and the only thing I can suggest is talking to the company's management and/or medical director. As far a I'm concerned, the PCR should be completed before clearing on any call, especially emergency calls.

 

[jbar]

The problem is that in some systems they are so busy there are already calls holding when they get to the hospital and you have to turn and burn. But that should be the exception nationally rather than the rule.

 

[Siggy]

Then that's an issue of being understaffed and needs to be fixed. Maybe I'm just a naive OMS1, but I can't imagine a physician or RN going home at the end of a shift and saying, "Oh, don't worry. I'll just finish charting at the start of my next shift." This is essentially what's happening when the hospital isn't getting the EMS chart until 24 hours later.

 

[greytmedic]

Two of the places I have worked (1 city fire/ems the other county ems) we were not cleared from a call until the run sheet was completed and placed in the ED chart. Both places it was policy that patient care and transfer of care was not completed until the run report was completed. Very rarely did we go on a call before the run sheet was completed. These were the exceptions and usually it was only if another call came in that was right around the corner or sounded pretty serious, and then we always high tailed it back to the hospital and completed the run sheet as soon as possible. At the county ems job we were still using hand written reports but at the city fire/ems we were using computer reports and had several computers with printers in the squad room at the ED.

The other place I worked (Private 3rd service) we were using computer reports but only had laptops and no place to plug them in at the ED. What usually ended up happening is we would finish the call, clear the hospital, and go back to the station to finish/print the report. These would get stuck in a box someplace that would eventually get faxed to the hospital when the dispatcher and/or the shift supervisor felt like faxing them. Many times these would still be sitting in the box the next morning. That always irked me and I just felt like it was incomplete patient care.

 

[emtcsmith]

In PA I believe the standard is a code/trauma chart must be done within three hours, and all others within twenty-four hours. All charts are electronic within the state.

At my FT city ems job all our charts are completed on tablet-like computer, send via broadband network to somewhere? then from that mytical point can be pulled by the hospital. Some hospitals have docking stations for our computers and charts can be printed but I believe that is not the norm.

 

[VeerTheTIGuy]

at the ED I used to be at, the medics all had Palm pilots, but all the printers in the department had IR ports...after unloading the patient, they would just walk up to any printer, beam it over, put the run sheet in the chart and head out