That is not how you address one on the telephone.. *vent*

[Forever Sunshine]

One of my residents was sent out to the hospital today. This evening I called over to the ER to check on how he was doing. I had to explain why I was calling about 4 different times to 4 different people.. and not one of them was polite. I was literally treated like a telemarketer.

I mean even when I'm having the worst of days.. I still manage to dig deep down and find a smidgeon of a good mood to at least smile and act humane to the person on the telephone.

Don't think thats asking for too much. My job is busy too.

[waksbr]

Ha ha ha ha:lol2:

"Hmmmm, was that a sincere sorry, or were they making a liar outta KB?"

Lol....didn't even think about it but yes it was sincere.

[eriksoln, BSN, RN]

I work ED. It drives me crazy when people answer phones and don't identify themselves. It's rude. There's no excuse for it, but on the other hand, I'd point out that the OP doesn't know if the nurse taking care of his/her patient is receiving her fourth ambulance in an hour, either. Maybe there's a code -- or two -- going on. Maybe every bed is full, the waiting room is 30 people deep, and patients are crashing. Yes, rudeness is inexcuseable. But I try to give folks the benefit of the doubt when I can't see what's going on. It is, after all, an emergency department.

When I worked LTC and had to call the ER I now work in, I'd let the secretary know that I was calling regarding Patient X, needed an admitting diagnosis, and would appreciate a chance to speak to the ER nurse when it was convenient. Could I leave my number? I didn't have to explain my issue over and over again, and I wasn't pulling a nurse away from an emergent situation to ask questions for which there might not yet be any answers. If the nurse was nearby, the secretary would ask if he/she had a moment to talk with me. Often the secretary can answer: he's still being evaluated, or yes, he's being admitted, I'll have the nurse call you.

Hmmm. And the riddle begins to unfold a bit. Unless, by some incredible coincidence, you are from the same facility as the OP..........seems a lot of different LTC facilities require this documentation. For all I know.........they all do. I know I've gotten calls myself but I always assumed it was just...........a nurse who had known the patient for a long time and was personally interested in their well being (hence my vague but true response of "They are doing well, home meds ordered, resting in bed blah blah").

Seems it is a universal need to document this info. My question at this point would be...........shouldn't this be done by admin./medical records/case management? Why is it falling on the laps of nurses? Oh.......don't answer that, I know the answer, just saying...............

Anyway, my point is, it seems as though it would not be a violation if this info. is being required by JACHO and the powers that be.

[cherrybreeze, ADN, RN]

Requiring an admitting diagnosis is one thing, but I still am wondering why the TIME they were admitted matters. That could vary greatly based solely on how busy the EC was that day, or if a bed wasn't available. I don't understand why that is relevant...

[Freedom42]

The facility I worked at required an admitting diagnosis to be included on the shift report. On several occasions, for example, I sent patients to the ER who were ultimately found to be dig toxic. Management needed to be aware of that. On one occasion, I sent in a patient who was diagnosed with dehydration. How that came to be on a skilled unit needed to be explored -- so that's why the admitting dx was included on the report.

Why did I ask to speak to the nurse if possible? Because s/he might have picked up on different issues in assessment, and I need to know that to improve the care I provide.

[NurseKatie08, MSN]

Yes, it is very complicated. So you are saying its not the same as a D/C. That's interesting and would explain the phone calls AND how HIPAA is being respected if the patient is not fully D/C'd from the prior facility. Actually..............TBH, I wonder if Case Managers aren't the best to answer this.

You might be right about that too that it is not complete D/C. I've had staff from other facilities, on the clock with their facility, come to be a 1:1 sitter with a special needs patient (autistic plus MR patient who rose OOB frequently). So, obviously, they are still on the case........................in some way/shape/form.

LTC/Rehab nurse here...as alluded to by a PP, bed hold is not the same as discharge. When a LTC resident (speaking only from my experience in my facility, but I'm sure it's somewhat applicable in other facilities) is sent to the hospital, in the 24 hour report book we document them as on MLOA (medical leave of absence). In fact, we don't even remove them from our e-Charting system (meds/treatments are just also documented as held due to MLOA). When they return to the facility, their diagnosis list is updated & discharge med list is reconciled with what they were on in the facility, however they are not considered a whole new admission. When our rehab patients are admitted to the hospital & then return to the facility, they are considered a whole new admission.

Perhaps a case manager may be able to shed some light on this subject in relation to medicare regs.

[David13, MSN, RN]

Yeah, but the "become better informed" part isn't that easy. Not that I've really put any effort into solving the riddle, but I'm willing to guess.............there really is no answer to be found.

Fill a room with 100 "HIPAA experts" and you are bound to get......oh, pretty close to 100 different answers to whether HIPAA has been violated or not.

But, eh, rudeness probably isn't the best retort if you believe it is a violation. Could simply just state your problem and put it on the table............"Sorry, but I'm uncomfortable answering this question." Or, you could simply go to the patient and ask for their permission to talk to the LTC facility. That would at least help if later on the question of HIPPA violation comes up.

Exactly! :cheers:

If it were me, and I got this type of call frequently, I am pretty sure I would make the effort to find an answer, or at least, the policy of my facility. However, the alternatives presented above are both preferrable, in my opinion, to simply answering rudely.

[Altra, BSN, RN]

Requiring an admitting diagnosis is one thing, but I still am wondering why the TIME they were admitted matters. That could vary greatly based solely on how busy the EC was that day, or if a bed wasn't available. I don't understand why that is relevant...

The time is relevant because it starts the clock ticking on the bed hold issue.

Again, I'm sure that an LTC nurse can explain that better than I can.

I'm very surprised that some of my fellow acute care/emergency nurses posting on this thread have expressed the view that because a patient presents to the ER, they have been "discharged" from their LTC, and therefore the LTC nurses have no business knowing about the patient's status. I just don't understand where this idea would come from. Yes, there are many patients whose LTC stay is limited -- rehab-type patients -- but I'm talking about the large numbers of true Long Term Care patients. Even if they come through the door stating that, "I'm not going back to XYZ Facility" ... this is simply not reality. If they were well enough to leave LTC, believe me, their insurance would have already stopped paying and they would have been discharged.

[Forever Sunshine, ASN, RN]

I work ED. It drives me crazy when people answer phones and don't identify themselves. It's rude. There's no excuse for it, but on the other hand, I'd point out that the OP doesn't know if the nurse taking care of his/her patient is receiving her fourth ambulance in an hour, either. Maybe there's a code -- or two -- going on. Maybe every bed is full, the waiting room is 30 people deep, and patients are crashing. Yes, rudeness is inexcuseable. But I try to give folks the benefit of the doubt when I can't see what's going on. It is, after all, an emergency department.

When I worked LTC and had to call the ER I now work in, I'd let the secretary know that I was calling regarding Patient X, needed an admitting diagnosis, and would appreciate a chance to speak to the ER nurse when it was convenient. Could I leave my number? I didn't have to explain my issue over and over again, and I wasn't pulling a nurse away from an emergent situation to ask questions for which there might not yet be any answers. If the nurse was nearby, the secretary would ask if he/she had a moment to talk with me. Often the secretary can answer: he's still being evaluated, or yes, he's being admitted, I'll have the nurse call you.

I did identify myself. I did explain why I was calling. I was very polite professional and honestly.. if I had four ambulances, or codes going on.. answering the phone would be the last thing I do. I'm not having my thread turned into whos busier.

[bjaeram]

The patients are residents at these LTC facilities. Don't the nurses and staff have a right to know what is going on with the resident, when they might be coming back, should they hold the bed or give it away? They are still residents of the facility and the facility has a right to know. In fact I think we as ER nurses really should be calling to give a report to the LTC nurse as far as the dispo. Are the coming home, being admitted, ect.

Besides anyone in the world can call a hospital and ask if a pt is admitted and it's not a violation of HIPAA. It's public record unless the patient asks it not to be.

[Forever Sunshine, ASN, RN]

Hmmm. And the riddle begins to unfold a bit. Unless, by some incredible coincidence, you are from the same facility as the OP..........seems a lot of different LTC facilities require this documentation. For all I know.........they all do. I know I've gotten calls myself but I always assumed it was just...........a nurse who had known the patient for a long time and was personally interested in their well being (hence my vague but true response of "They are doing well, home meds ordered, resting in bed blah blah").

Seems it is a universal need to document this info. My question at this point would be...........shouldn't this be done by admin./medical records/case management? Why is it falling on the laps of nurses? Oh.......don't answer that, I know the answer, just saying...............

Anyway, my point is, it seems as though it would not be a violation if this info. is being required by JACHO and the powers that be.

Admin/medical records (we don't have case management nurses) .. are gone like the wind by 4pm. This is mostly done in the evening. (Unless the resident was sent out early in the morning). And even if they are there.. we would still be the ones doing it.

I'm not calling for my own personal interest. Otherwise to be honest.. I wouldn't call. I think the phone rings too damn much on my unit.

[Freedom42]

I did identify myself. I did explain why I was calling. I was very polite professional and honestly.. if I had four ambulances, or codes going on.. answering the phone would be the last thing I do. I'm not having my thread turned into whos busier.

Sorry, I didn't mean to imply a "who's busier" aspect. I only meant to suggest that calling and immediately asking to leave a message, rather than repeating your request to four people, might be more convenient for all concerned.

[Forever Sunshine, ASN, RN]

The patients are residents at these LTC facilities. Don't the nurses and staff have a right to know what is going on with the resident, when they might be coming back, should they hold the bed or give it away? They are still residents of the facility and the facility has a right to know. In fact I think we as ER nurses really should be calling to give a report to the LTC nurse as far as the dispo. Are the coming home, being admitted, ect.

Besides anyone in the world can call a hospital and ask if a pt is admitted and it's not a violation of HIPAA. It's public record unless the patient asks it not to be.

I'm not sure how bed-holds work but if they are admitted to the hospital they can lose their bed or the family can pay for a bed-hold. Thats all I know about it.

I've only had maybe two ER nurses call me and ask about the patient. They were both very polite and professional. I would have no problem giving them a history of the resident or taking a phone call from the ER nurse about whats going on with the resident.