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Coming to a Hospital Near You: E-prescribe

To further complicate matters, what if the physician who ordered the test was a consultant? I am not aware of any rules specifying provider responsibility for notifying the patient. I typically recommend the hospitalist in charge of discharging the patient from the hospital make a practice of looking for studies whose results are pending at the time of discharge. The hospitalist should inform the patient the results are pending and discuss a plan of action for the patient to get the study results. Then I suggest the hospitalist document this discussion and plan/forward this documentation to the provider who is scheduled to see the patient in follow up. It is typically easier for hospitalists to include this information as part of the discharge summary sent to the PCP.

As you suggested, these steps may be insufficient when the patient does not follow up with the designated PCP. For that reason, it is necessary for the hospitalist who discharged the patient to follow up on these pending results. The hospitalist must notify the patient if the results are abnormal. To do this, prior to hospital discharge, one needs to know how to contact a patient post-discharge. Always document the fact you have notified the patient of the abnormal result. I recognize this type of follow up is not easy after a patient is discharged, especially when most results will return as normal studies. The volume-to-noise ratio is not great. But it is that one out of 100 abnormal result that will end up hurting the patient and potentially result in litigation.

One important piece of advice: Only order necessary tests. The fewer tests you order, the less it is likely you will have test results pending at discharge. If a test is not likely to change how you manage a patient during their inpatient stay, consider not ordering the test. Such practice is not only more cost-effective care, but also simplifies the system and minimizes the risk of error associated with notifying patients of abnormal test results.

A Little Common Courtesy, Please

I find it incredibly annoying when we are holding a staff meeting and some of my colleagues are checking e-mail on their Blackberry. At the risk of sounding like a codger, is it too much to ask for some common courtesy?

K. Moore, Austin, Texas

Dr. Hospitalist responds: You are, of course, correct at pointing out it is rude for people to check messages during meetings, not to mention anytime a supervisor or colleague is speaking. Do I condone the behavior? No. Do I understand the behavior? Yes. (In the spirit of full disclosure, I am addicted to my Blackberry and, occasionally, am guilty of checking for messages when I should be paying attention).

We live in an information age and the expectation for communication is greater than ever. As hospitalists, we know this all too well. For many of us, the Blackberry affords us the opportunity to multitask, shaving minutes or hours off our workday. I agree it is not an unreasonable request to ask everyone to turn off their cell phones and put down their Blackberrys during meetings.

That said, doing without the Blackberry for much longer than an hour or two is not an option for many of us.

Please note President-elect Obama will have to ditch his Blackberry this month, if not sooner, due to concerns surrounding e-mail privacy. He also is subject to the Presidential Records Act, which eliminates any privacy regarding this correspondence. (Memo to self, another reason not to run for president.) TH

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