Is it appropriate to check on pts?

bethin · Jan 17, 2007

I would think it would be a HIPPA violation. The pt is no longer under your care so you don't have a right to that info.

allantiques4me · Jan 17, 2007

That sounds very kind.But Im not sure about the HIPPa thing either.

TazziRN, RN · Jan 17, 2007

I think this is a grey area. We are a rural facility so we transfer out to tertiary facilities a lot. It is part of our protocol to do a follow-up by phone the next day to see if the diagnosis is the same and how the pt is doing. We brought up the HIPAA concern about this, and we were told by our bosses and risk management that this is part of continuing care. I'm not sure how, but that's what we were told. Most nurses we talk to at the receiving facility are willing to talk to us without going into detail. The nurse doing the followup has the chart in front of her; if I ask specific questions like "Did the pt have surgery" or "How did he respond to the angiogram?" the questions are almost always answered. Sometimes the receiving nurse is not comfortable saying anything other than "Pt is stable/not stable" and that's what we chart in the followup.

stillpressingon · Jan 17, 2007

HIPPA violation

morte, LPN, LVN · Jan 17, 2007

Hipaa

Shamira Aizza · Jan 17, 2007

I was just wondering if you think it's appropriate to call a unit/hospital where you sent a pt from the ED to see how they are doing. Does anyone here do this?

NOT at HIPAA violation.

Reason it's not a HIPAA violation is because you were involved in patient care.

The whole purpose of HIPAA is in fact to streamline the transfer of information between sending and receiving facilities and all involved providers, and HIPAA specifically recognizes the importance of Continuous Quality Improvement.

It's not unreasonable if the receiving facility chooses not to give you an update, but it's fairly irresponsible to refuse simply for fear of violating HIPAA, because patient care is a process, and Quality Improvement should be "Continuous," meaning that the entire process should be reviewed by conscientious providers for purposes of Quality Improvement.

Two of my previous employers had a specific program in place, reviewed and approved by legal, where they provided automatic feedback to all referring hospitals. Automatic, no request for info required, approved and legal by HIPAA.

Of course you are in violation of HIPAA if you share this info improperly with someone who wasn't involved in the care of that patient.

SharonH, RN · Jan 17, 2007

NOT at HIPAA violation.
Reason it's not a HIPAA violation is because you were involved in patient care.
The whole purpose of HIPAA is in fact to streamline the transfer of information between sending and receiving facilities and all involved providers, and HIPAA specifically recognizes the importance of Continuous Quality Improvement.
It's not unreasonable if the receiving facility chooses not to give you an update, but it's fairly irresponsible to refuse simply for fear of violating HIPAA, because patient care is a process, and Quality Improvement should be "Continuous," meaning that the entire process should be reviewed by conscientious providers for purposes of Quality Improvement.
Two of my previous employers had a specific program in place, reviewed and approved by legal, where they provided automatic feedback to all referring hospitals. Automatic, no request for info required, approved and legal by HIPAA.
Of course you are in violation of HIPAA if you share this info improperly with someone who wasn't involved in the care of that patient.

:yeahthat: It IS appropriate and NOT a HIPAA violation.

WahooRN08 · Jan 17, 2007

I feel it is inappropriate to ask for medical information. I often find it annoying when I am working on the floor and nurses from the sending facility are calling throughout the day to check on the status of a patient. I usually will redirect them to case management.

cardsRN · Jan 17, 2007

i think this is completely appropriate, as other posters have stated- the sending team was involved in the care of the pt and is seeking info for quality improvement issues. my facility has a procedure in place. the sending facility (or medflight crew) has a code assigned to the pt and they give me the code matching to my pt and that is clearance to release info. they usually only ask if the dx is the same, what procedure/surg the pt had on arrival and if they're stable now. it's all legal in in accordance with my facility's policy, and i'm happy to help other providers improve outcomes. now, as another poster stated- nurses from outside hospitals calling for updates throughout the day... that may be for more personal reasons and may be inappropriate. i would refer those cases to your supervisor if i were you. my $0.02

obliviousRN · Jan 17, 2007

We routinely do follow up calls on our pts we transfer out. We use it as a QI process. By obtaining the info we find out many things:

1. could we have changed the outcome by our initial treatment?

2. was there something we could have done better/quicker/etc.?

3. how can we use this case to improve care given in our ER?

4. were actions deemed appropriate by the receiving facility?

It's not just a nosey "how are they doing?" It's a true data gathering process that can change how we provide care in our rural ER. In Oregon at least, there are state statutes that allow us to receive this information and it is NOT a violation of privacy.

rn/writer, RN · Jan 17, 2007

I agree with those who have cited Quality Improvement as a valid and legal reason for inquiring.

Your facility should probably designate a specific contact person (or two) who would handle inquiries and responses. This is important for a couple of reasons.

First, it shows a definite protocol in place.

Second, it's more professional (and likely to be met with a better response) than having several nurses call independently because they didn't happen to see each other to discuss the outcome.

Third, the contact person can develop an ongoing relationship with the most frequent transfer facilities and give them the reassurance that the healthcare history and details of the patients are being handled in a secure fashion on the other end.

When I was an EMT, we had this kind of a set-up with two of the hospitals we transported to. The feedback was invaluable, not only because we were concerned about the person, but, as others have mentioned, we wanted to know if we "called it right" and if there was anything we could have done differently to improve the outcome. The information was shared in detail with the crew members who had been on the call, and, to a lesser, non-identifying degree with other members in training sessions. We learned much from such sessions. And we felt an enormous satisfaction when we heard that we had done well in our decision making.

HIPAA correctly does make provision for QI within the continuity of care.