So very frustrated at a recent experience that I had at my job. I work in a busy ED and occasionally we receive patients who are "referred" from an outside urgent care. I have personally received phone calls from a particular urgent care informing us that there is a patient coming over and they continue on by providing ALL protected information about this patient, after they have discharged them, and why they cannot treat them there. It is important to note that the urgent care completes their care of the patient and then discharges them from their system, the patient leaves and may or may not elect to come to our emergency department. The last phone call that I received from this urgent care went about the same as usual but at the end of the conversation the nurse on the other end of the phone call says and what is your name. I paused, as this is not a common request and stated, I have no problem providing my name, heck I answer the phone stating my name, but I must clarify that there is no RN-to-RN report occurring here as this is not a transfer and there is no transfer of medical authority and/or medical accountability between facilities, additionally providing all of the protected information about the patient could constitute a violation of HIPAA as we do not have a need to know since it is not a transfer. I brought this up to the nurse due to her requesting my name as it made me think she was charting it somewhere, which really seems like a bad idea for HER and HER ORGANIZATION to be documenting an inappropriate release of patient information.
So... you can probably imagine how this was received. The nurse didn't say anything to me regarding the issue, but was actually agreeable stating oh yes we are just providing info on the patient (smiles and warm fuzzies here), phone hangs up no big deal, and by the way the patient never came to our ED. Fast forward about two weeks I receive a phone call from my director stating she has a disturbing email about a phone call that occurred with an urgent care. For the sake of the readers time I will summarize, the email stated I did not want to give my name in addition to me be terse and maybe rude (can't remember), and the final sentence stated "should we not be sending patients to your ed any longer as you don't want info on them", a basic threat to pull business away. You, the reader, should know that I work for a for profit hospital and this last sentence had all the teeth to ensure my director would act, and act she did. I get a call, she is super matter of fact, basically telling me to just listen and don't say anything back to those who are calling us regardless of appropriateness as customer service is our goal and... well you can fill in the rest.
I am disturbed to my nursing core. I have been a nurse now for about 6 years, to some thats nothing and others thats a good amount of time. I haven't seen a lot of malicious behavior like this and I think it is why I am struggling with it. I guess my issue is when nurses cannot listen to constructive criticism without personalizing it and making it about the person communicating it. I get my directors response, she MUST act on this as it is threat to community business relationship and thats to be expected. What I don't get is the fabrication of scenario to elicit a response from my leadership, it really feels icky. I do know that the nurse I was speaking with has been a nurse for about two years, I offer this for context. I assure you that I was nice and pleasant in my conversation with the nurse, and cannot understand why she would paint our conversation in such a way. I can only assume her intellect was offended and she "reacted", instead of considering what she was actually doing, violating protected information (albeit trying to be helpful). I read a post on here by Riseupandnurse that stated due to nurses having to take whatever is dished out by admin, physicians, patients, families, etc, that there is a great deal of free floating anxiety and hostility and sometimes finds its release valve on an unsuspecting victim. Additionally, I feel that there is a great deal of insecurity that we all deal with and sometimes instead of recognizing this and overcoming how it makes us feel then learning from it, we fall victim to self preservation and restructure reality in order to ensure we are righteous and the other, perceived adversary, is wrong and we demonize them and their actions or intended message. When this occurs it is a hugely flawed weakness in psyche, that ultimately is self defeating and greatly inhibits personal growth.
I guess I am posting this for therapeutic purposes, and maybe some stimulating conversation can result.
Honestly, if I had been the Nurse on the other line I would have just documented "Nurse spoken with refused to give her name at end of call" or something to that effect and been done with it. I wouldn't have made a big stink over it. It's also possible that she asked her boss about it and her boss took offense and wrote that email. It's also possible the OP came across as a know it all and possibly quite curt in her explanation of HIPPA violation. People tend to take things personal especially when their own knowledge is insulted.
What's the big deal if someone asks you your name, even if you said your name when you answered the phone? I'm not getting what the original fuss was all about.
Please, everyone. take a step back and reread. the OP clearly stated that some of these patients don't come, that makes sharing their info wrong. solution: the sending entity has preprinted form okaying sending/calling of info, has patient/guardian sign it, that is faxed to receiving facility prior to calling, or with faxed report. if the patient has no intent to go to the hospital, they can simply refuse to sign.
Please, everyone. take a step back and reread. the OP clearly stated that some of these patients don't come, that makes sharing their info wrong. solution: the sending entity has preprinted form okaying sending/calling of info, has patient/guardian sign it, that is faxed to receiving facility prior to calling, or with faxed report. if the patient has no intent to go to the hospital, they can simply refuse to sign.
Except that the law already covers legitimate disclosures and there is no reason to believe this isn't a legitimate disclosure. The patient has not given them any reason to believe s/he disagrees with the plan and/or doesn't approve of it or intend to follow it. The fact that the patient changed his or her mind about following medical advice between point A and point B doesn't invalidate the original intent or purpose of the disclosure. There is no separate consent required in order to share information for ongoing patient care (outside of certain delineated disclosures beyond regular medical care) - this has been a very common misunderstanding for years.
If the patient gives no one any reason to think s/he isn't going to follow the recommendation, everyone is already covered. But your post reminds me of a tangential point: If the patient clearly has no intention of following the recommendation, possibly to his/her own detriment, then AMA procedures should be followed, which serve not to "punish" the person who doesn't intend to follow the advice, but to serve as an acknowledgment that they were given all information relevant to their decision-making process and are hereby making a cognizant, well-informed choice not to follow the medical advice given.
The second linked question uses the language "will treat" - that is futuristic, as opposed to the wording, "is treating" or "is evaluating." No one can guarantee that any person or entity will end up treating any particular patient. Thus, your understanding of the situation is not the way it was intended to be understood and would mean that no PHI could ever be requested or disclosed unless the patient was already physically present in Place #2.
Resident in LTC is showing signs of pneumonia. The staff makes the appropriate arrangements to send the patient out to the nearby ED. They copy the chart and send it with the patient. They call report to the ED RN. En route, the patient begins to show signs of acute stroke, and when the medics call in the change in condition, the ED/med control directs them to take the patient priority 1 to another equidistant ED in the system that is a Comprehensive Stroke Center. [Assume this is not an EMTALA "dump" but is indeed the right and good thing to do for the patient].
LTC has now "violated HIPAA" because the patient didn't end up going to the ED that received the LTC's original phone report?
Interpolfan89
41 Posts
Honestly, if I had been the Nurse on the other line I would have just documented "Nurse spoken with refused to give her name at end of call" or something to that effect and been done with it. I wouldn't have made a big stink over it. It's also possible that she asked her boss about it and her boss took offense and wrote that email. It's also possible the OP came across as a know it all and possibly quite curt in her explanation of HIPPA violation. People tend to take things personal especially when their own knowledge is insulted.