Courtesy notification and EMTALA

[MagicTyler]

Can you give a courtesy notification to a lower level of care?

 

[VFlutter]

Can you be more specific? And do you mean HIPAA instead of EMTALA?

 

[Medic Tim]

What is a courtesy notification? Hospital call in? Transfer of care at hospital?

Either way you can pass pt care to a lower provider level with a report.

 

[JPINFV]

What do you mean by a courtesy notification for a lower level of care?

 

[mycrofft]

OP, step back from the crater and tell us more!

 

[Trashtruck]

I'm glad I'm not the only one who doesn't know what a 'courtesy notification' is...

But to answer your question...Sure! Go for it!

 

[MagicTyler]

Sorry I never relized courtesy notification wasnt standard lingo ( its used throughout AZ by several hospital systems). A courtesy notification is when you radio/call into the hospital and give an ETA, ect. but dont require any orders. Can you give that info to just a secretary or CNA? Ive always been taught that EMTALA does not allow for care to ever be passed to a lower level of care, that it must be the same or equil. My question is does this include a radio update?

 

[DesertMedic66]

All of our radio contacts are on a recorded radio or cell phone line. The only people who can answer the radios/phones for radio reports are MICNs. They are RNs with a special MICN class and field hours (have to due a certain amount of ride hours on the ambulance).

If we need orders then the MICN gets the Dr on the phone or will verbally ask the Dr.

 

[JPINFV]

Sorry I never relized courtesy notification wasnt standard lingo ( its used throughout AZ by several hospital systems). A courtesy notification is when you radio/call into the hospital and give an ETA, ect. but dont require any orders. Can you give that info to just a secretary or CNA? Ive always been taught that EMTALA does not allow for care to ever be passed to a lower level of care, that it must be the same or equil. My question is does this include a radio update?

1. EMTALA doesn't have an effect on non-hospital based ambulance services.

2. Since it came up, HIPAA allows sharing of information as needed for treatment, billing, and health care operations. Entry/courtesy notifications would apply to at least 2 of those.

3. Entry/courtesy notifications are not a transfer of care, therefore it isn't transferring to a lower level of care.

4. Every time a patient is discharged, they are arguably being transferred to a lower level of care, especially if the patient doesn't have a PMD.

 

[DrParasite]

courtesy notifications are just that, courtesy notifications. They are usually given so you have a bed waiting for you. maybe so they can have specialized equipment, that's all.

We typically give reports to nurses or doctor. Usually the head nurse or whomever is in charge, and maintaining a bed status for the ER. I guess we could speak to a secretary or unit clerk, but the nurses are typically more responsible than a unit clerk and secretary, and knows the bed status and where the patient will be going.

 

[abckidsmom]

Depends on the hospitals policy in my experience. One local hospital has an office staffed with medics who take report, the rest just have the charge nurse do it.

 

[Handsome Robb]

Doesn't matter unless the specific hospital has a policy on it. We give radio reports to whoever answers the radio. Anywhere from a unit clerk all the way up to an MD on rare occasions. I've given a standard ALS radio report, not asking for any orders, to our lead trauma surgeon who just happened to be sitting at the desk and the charge nurse asked him to answer the radio because she was on the phone and had her hands tied up. Generally it's a Paramedic ER Tech or an RN though.

Like others said, you aren't transferring care, just a "hi, we will be there in a few get ready!"

HIPAA shouldn't apply because you shouldn't be broadcasting identifying information about the patient over public airwaves. It will if you do though and someone complains about it or reports it!

 

[abckidsmom]

HIPAA doesn't apply because you are sharing PHI for a reason that is technically necessary for patient care.

 

[WuLabsWuTecH]

HIPAA shouldn't apply because you shouldn't be broadcasting identifying information about the patient over public airwaves. It will if you do though and someone complains about it or reports it!

HIPAA doesn't apply because you are sharing PHI for a reason that is technically necessary for patient care.

Thank you!

I always struggle to find people who understand that 1) HIPAA doesn't apply to dispatching agencies in most cases and 2) even if HIPAA were to apply, using a patient's name on the radio, if necessary for patient care, is not a violation of HIPAA or privacy laws.

2 examples that I always use.

1) We are dispatched to Dilapidated Apts on a patient injured in a fall and can't get up--a very typical dispatch. Address is 1000 N. Main Street, Apartment 304A. We arrive, and come up to the front door. The numbers on the main door are all old and worn out so there is no 304A that we can see. However, next to the buzzers are the people's names. We can mark dispatch on the radio and ask for a name to assist in locating the patient. I will usually in this case ask for a first name, if that doesn't work, ask for a last initial, and failing all else, ask for the full name, just to protect privacy a bit, but I am not required by law to do this.

2)En Route to a hospital because of a patient's condition and the fact that she received special care there. The physician wants to order something further than what we already did. We caution him that this patient has NeverHeardOfDisease and stated she needed to be careful with [insert type of treatments here]. Physician thinks that she really needs this, and wants to pull up her chart to look and/or consult the service (remember that our transports can be over an hour with 42 minutes being the average so plenty of time for this to happen). In order to do so, I can provide a name and DOB over the radio as it is necessary to provide patient care.

 

[Medic Tim]

Thank you!

I always struggle to find people who understand that 1) HIPAA doesn't apply to dispatching agencies in most cases and 2) even if HIPAA were to apply, using a patient's name on the radio, if necessary for patient care, is not a violation of HIPAA or privacy laws.

2 examples that I always use.

1) We are dispatched to Dilapidated Apts on a patient injured in a fall and can't get up--a very typical dispatch. Address is 1000 N. Main Street, Apartment 304A. We arrive, and come up to the front door. The numbers on the main door are all old and worn out so there is no 304A that we can see. However, next to the buzzers are the people's names. We can mark dispatch on the radio and ask for a name to assist in locating the patient. I will usually in this case ask for a first name, if that doesn't work, ask for a last initial, and failing all else, ask for the full name, just to protect privacy a bit, but I am not required by law to do this.

2)En Route to a hospital because of a patient's condition and the fact that she received special care there. The physician wants to order something further than what we already did. We caution him that this patient has NeverHeardOfDisease and stated she needed to be careful with [insert type of treatments here]. Physician thinks that she really needs this, and wants to pull up her chart to look and/or consult the service (remember that our transports can be over an hour with 42 minutes being the average so plenty of time for this to happen). In order to do so, I can provide a name and DOB over the radio as it is necessary to provide patient care.

While this is legal your agency may have a policy /SOP on this that is more stringent. Just a warning to those that see this and decide to do it where they work. Ex. We are to use radios as a last resort in these types of cases.

 

[Handsome Robb]

While this is legal your agency may have a policy /SOP on this that is more stringent. Just a warning to those that see this and decide to do it where they work. Ex. We are to use radios as a last resort in these types of cases.

I'll second this. If you're going to share information like that it should be on the phone not the radio, but that's just my opinion. Plus it's easier to consult with the doc on the phone than trying to go back and forth on the radio.

 

[WuLabsWuTecH]

While this is legal your agency may have a policy /SOP on this that is more stringent. Just a warning to those that see this and decide to do it where they work. Ex. We are to use radios as a last resort in these types of cases.

Thank you, Tim. I should have made that very clear. While this is legal it may not be permissible under your own employer's SOPs/handbook/etc.

I'll second this. If you're going to share information like that it should be on the phone not the radio, but that's just my opinion. Plus it's easier to consult with the doc on the phone than trying to go back and forth on the radio.

I find it much easier to use the phone when possible, but they stopped putting those car-phones in our medics many years ago, and with a personal cell without an external antenna, it is sometimes very hard to get a clear signal from within the medic. Also, I tend to leave my cell phone on the charger in the station or in my POV... oops! :unsure:

 

[18G]

1. EMTALA doesn't have an effect on non-hospital based ambulance services.

In the case of inter-facility transfers it does. And that is the whole point of EMTALA.

 

[JPINFV]

In the case of inter-facility transfers it does. And that is the whole point of EMTALA.

They have an effect on those setting up said transport, but not on the ambulance crew itself.

 

[18G]

Indirectly EMTALA does. The ambulance crew must have or be provided all necessary equipment and medications to provide the care required during transfer.

I run into an issue sometimes where the sending hospital does not want to provide the necessary analgesic and sedative medications which effects the ambulance service.