Contacting the Dr for follow up orders.

[tabster224]

I had a incident here today, I was wondering if anyone else has ran across it, or been on either end of the conversation.

I did a SOC today for a patient that had just got out of the hospital following a MVA. Pt and nursing were ordered for the patient. If both PT and nursing are involved, we (nursing) have to open the case first. I called the Doctor after I got home and sat down, and got a hold of his nurse (not sure if she was a MA, RN, LVN or what, I never got that far). She started reaming me telling me that they had no idea this patient had been in an auto accident let alone in the hospital and wanted to know why I didn't call her(the doctor's office) before I went to see the patient. I explained that the hospital Dr had requested the SOC, so we had the initial order for the SOC and PT eval, what I was calling her for was to make sure her Doctor (her primary care Doc) would sign the home care orders, and OK the following Nursing care for the patient. Before I could get out my frequency and what I was going to do for the patient, she states "are you the DON?" I said no, I am just the nurse that went to start patient for home care, and she said, you are calling after the fact of seeing this patient, and expect the doctor to OK care, we had no idea she was in the hospital. It is your responsiblity to make sure we get all the hospital paperwork, you need to fax it to me. I said to her "the home care company?" she states yes, you expect him to sign the homecare orders after you have already seen her when we had no idea she was in hospital, and without that paperwork from the hospital (for some reason I thought it was the hospital's place to fax paperwork to the doctor's, I have never had to fax the hospital paperwork to a doctor). I again explained to her that we have the initial order for the SOC and she states "look I use to run a home care company, I know what the rules are, you are responsible for calling the doctor's office before you ever go out to the patient, and to get us the paperwork from the hospital. She also said that she always called every doctor on each referral before her nurses ever went to see the patients. I said to her, I will have to call the office to see if I can get someone to fax you what paperwork I got and I will give you the phone number of the office and you should ask for C****** she's the nurse in charge. She angerily stated, no she should have already called me before you ever went out there. So I finally said fine, I will call her, and have her call you thanks, and hung up before I went off on her. I have never, never had a nurse at a Doctor's office talk to me that way, and have never had one refuse to sign because we had not called the office before we went out. Just wondering if this is common practice with office nurses (I have never had this happen before, maybe I've just been lucky)? I mean I understand where she was coming from to a certain extent, but most Doctor's are glad we are out seeing their patients especially after a hospitalization and MVA. Thanks for the input. I was so mad when I got off the phone because she was so very rude. BTW, I live in California not sure if that makes a difference.

[HmarieD]

Sounds like she could have handled that more professionally, but I think she is right. Speaking from similar past experience, you should always get a verbal SOC order from the physician who will be signing your POC before seeing the pt. This type of scenario is coming up more & more often as hospitalists are ordering HH at hospital DC but will not be following up.

The hospitalist and hospital DC planner/Case Mgr should have communicated with the pt's primary MD, but they often do not. You unfortunately got stuck in the middle. Your intake nurse (or whomever is accepting referrals) should start asking at the time of referral who will be signing your orders, and then obtain a VO from that MD. Always CYA.

[KateRN1]

Oh my. Lots of issues here. First issue is with the person you spoke with at the doctor's office. Rudeness is never acceptable. If it were me, I would speak directly with the physician about this "team member." Rarely do the office docs actually know what their staff does or how they behave on the phone, or how they often misrepresent themselves (MAs as nurses).

It's not your position to contact the PCP regarding the auto accident, that is the hospital case manager's position. Informing him about details of the accident and/or hospitalization is a HIPPA violation. If they want records from the hospital, they need to get a signed consent from the patient and send to the medical records dept at the hospital where she was treated.

Now, I've run into problems several times with PCPs not wanting to sign HH orders when they didn't initiate the consult. Best practice is to have the intake scheduler (or whover handles referrals) call the PCP and let them know that a HH consult has been ordered by the hospitalist and ask about their willingness to sign the plan of care. If not, then politely inform the case manager at the hosptial that the PCP is not willing and that if they want HH for this patient, they need to provide a physician who is on board.

Good luck. It sucks to be in the middle.

[tabster224]

Thanks for the responses. I do understand where she is coming from, and I will most likely from now on contact the PCP before going out to see patient. I doubt the intake people will ever do that even though they should be the ones making sure a Doctor will sign the orders. I really was shocked when she went off on me, but like I said I do see where she is coming from. You would think the hospital DC planners would let the doc's know their patient is in the hospital and make sure they get all info needed. Thanks again for the replies.

Bj

[traumaRUs, MSN, APRN]

Do these physicians have a mid-level provider? I often sign/give/approve HH orders and my only concern is if this will help facilitate pt care. Sorry, I didn't think this was a big deal and think it could have been handled far more professionally and quickly from the PCP MD's angle.

[KateRN1]

Tabster, don't apologize. *YOU* did nothing wrong in this scenario. Everyone else dropped the ball and you got stuck with a mess to clean up. As the field nurse, even if you practice primary case management, it is not (and should not be) your responsibility to make sure you have a doc to sign orders. That's what the intake coordinator is for. And the person at the PCP's office should never have spoken to you as she did; it was completely unprofessional, even if you can see where she's coming from, she's taken the wrong road to get there. Again, it's not your problem that this PCP didn't know his patient was in hospital post-MVA--that's the hospital case manager's/discharge coordinator's job and the PCP should've been notified as soon as the pt's insurance info was accessed.

Take a deep breath. You did what you were supposed to do, which was see the patient based on the HHC consult you received from the hospitalist and your intake personnel. You did your job, and I'm sure you did it well.

[tabster224]

Thank you for your response. I spoke today with my boss about that situation, and she stated it was the insurance case managers responsibility to let the doctor know. It was an insurance company that the patient had turned over her medicare benefits to, and she had approved 3 nurse visits. Even though she approved 3 we still have to get approval from the Doctor to continue seeing the patient. So she should have given the Doc a heads up on this patient. This office nurse should record her conversations and then listen to how she talks to people. I asked my boss to call her today to get the approval on the other visits, I didn't think I should be the one to call again.

[KateRN1]

Ah, those wonderful Medicare HMOs. Gotta love 'em. (NOT!)

[tabster224]

lol Exactly!

[Tampa121]

Spot on!

[kids]

My agency, we don't care who gave the orders no one is seen until our office contacts the doctor we're told will follow to confirm they want us to provide services.

Docs have agencies they prefer to work with, we've been shafted too many times because the hospital referred to us and the doc prefers to work with a different agency and re-writes the referral.

[tabster224]

I understand doing that, it makes sense. But I live in So Ca, and sometimes getting a doctor to call me back is like pulling teeth. I never had as much trouble getting doctors to call me back in Indiana or Arizona, but here it is totally different. I wonder if it is company policy when the referral is received to call the doc and it's just not done. I have worked for the same company in 3 states and off the top of my head, I don't remember them ever calling the doctor to OK us going out to see patients.