Trauma patients and not ordering ETOH/drug screens in ER.

[VizslaMom]

I work in an ICU in a Level II Trauma Center. I've noticed on some trauma admits in the past few months that ETOH and/or drug levels haven't been ordered. For example, I received a patient last month: 17 y/o involved in single car accident on the way home from a concert. No ETOH/Drug screen done on this pt. This weekend, we recieved a trauma pt. who had thrown herself from a moving vehicle and who was CLEARLY intoxicated - once again, no screens done.

I've been questioning other nurses on my unit and they all, like me, thought that it was a major oversight on the part of the ER physicians and nurses.

Come to find out yesterday, from the neurosurgeon, that this is being done (or NOT done) purposefully.

Why??

Because, aparently, some insurance policies have a clause indicating that they will not be held responsible for payment if the insured (pt.) is injured because of an ETOH or Drug related accident.

So, now our hospital has elected not to do the screens on the patients when it may affect payment to the hospital for services.

The neurosurgeon stated that he was being placed in a bad position because of this - and so are the rest of us IMO. He said that from a neuro perspective he should know if there is ETOH or drugs involved, especially in the case of head trauma - DUH! He said he's arranging to have a meeting with hospital administration to discuss this issue. (He carries some weight as he is our ONLY neurosurgeon and we NEED him on board in order to keep our Trauma II status. )

I think WE need to know as nurses so that we can be careful of not giving meds that may interact with ETOH or drugs and so that we can monitor for possible DT's or effects of overdose of ingested substances.

I totally disagree with this new "policy" and think it's putting our patients at risk!!

[traumaRUs, MSN, APRN]

We got around this by doing ETOH/drug screen on EVERY trauma pt. That is just the easiest way to handle thing, IMHO. The police can supoena the results or in my state, we are allowed to verbally furnish them the information if they ask.

[Blackcat99]

:angryfire That's awful. I think it's sad what has to be done nowadays in order to get financial reimbursement.

[VizslaMom]

We got around this by doing ETOH/drug screen on EVERY trauma pt. That is just the easiest way to handle thing, IMHO. The police can supoena the results or in my state, we are allowed to verbally furnish them the information if they ask.

It's not an issue of legality r/t the incident. If it's requested by police then it's done without a problem, of course. They used to do ETOH/drug screen on all trauma patients - at least that's what I think they used to do. I just noticed a difference in the past few months.

I also think this borders on insurance fraud. When a patient is OBVIOUSLY intoxicated or under the influence of something and a ETOH/drug level is not done because the hospital wants to be paid....it is fraud IMO.

[lifeLONGstudent]

17 y/o involved in single car accident on the way home from a concert. no etoh/drug screen done on this pt. this weekend, we recieved a trauma pt. who had thrown herself from a moving vehicle and who was clearly intoxicated

question: did the police draw a legal alcohol and if so, can't the insurance get a copy of the result through that avenue?

that is a crazy hospital policy. it seems like it sets up the neurosurgeons and any other attending docs as well as the hospital for a major lawsuit.

i work in the lab and would gladly do a drug screen and etoh for you off the record and even fax you a copy if you called me & explained the situation (and acted civil to me instead of ordering me to do it-- heee hee hee)