Sending Your Patient to the ED

[EMDOC17]

Had an interesting conversation with my fellow residents and one of the off service FM residents today. I am EM. We got talking about one of my patients. They got sent in for back pain and what I guess was rule out cauda equina. Patient said he was sent in as his Dr. was concerned he had "something bad and likely needed an MRI." I didn't feel he needed an MRI and after some discussion I discharged him home without the MRI. I am not bashing on the PCP for sending this patient in and I know how stories change/evaluations change. The PCP probably saw/heard something I didn't and maybe thought they really did need an emergent MRI but from what I saw they did not. It really got me thinking.

How many of you when you send a patient to the ED give the ED a call? It is not unusual for me to see 1-2 patients per shift sent from their PCP/urgent care/cardiologist/or whatever (more often urgent care or PCP). Usually they tell me Dr. X sent me and sometimes its obvious but not always. I personally think that if someone sends someone to the ED you should give us a call and a short run down of why. The FM resident brought up that we send people back to the clinic without a call.

I get that honestly almost every patient gets f/u with PCP in x days and those that don't get "follow up in x days if not improving". Very few get a call if any (I think you all would hate me if I called on every single patient that I discharged). If I am really concerned or absolutely need close follow up then I call (probably 1-2 patients a mont).

Honestly though I love conversations with PCP's. If they call and explain why they sent the patient over I have always done what they thought. When I have called them they seem to do the same. I am just wondering why more PCPs don't do this. If you are concerned enough to send a patient my way why not the 5 min call to tell me why?

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[VenusinFurs]

I agree with you, and the short answer is probably our practices are a ****show and we don't have enough time to practice good medicine.


I do always call the ED though

 

[deleted87716]

How many of you when you send a patient to the ED give the ED a call?

If I'm sending somebody to the ED directly from the office, I always call the ED, speak to one of the attendings, and fax over a copy of my office note and any pertinent studies. Since I may or may not get a call back from them later, I always have my staff call the ED the next day to find out about dispo, get notes, arrange follow-up, etc.

Anyone who doesn't has no excuse.

 

[smq123]

Had an interesting conversation with my fellow residents and one of the off service FM residents today. I am EM. We got talking about one of my patients. They got sent in for back pain and what I guess was rule out cauda equina. Patient said he was sent in as his Dr. was concerned he had "something bad and likely needed an MRI." I didn't feel he needed an MRI and after some discussion I discharged him home without the MRI. I am not bashing on the PCP for sending this patient in and I know how stories change/evaluations change. The PCP probably saw/heard something I didn't and maybe thought they really did need an emergent MRI but from what I saw they did not. It really got me thinking.

How many of you when you send a patient to the ED give the ED a call? It is not unusual for me to see 1-2 patients per shift sent from their PCP/urgent care/cardiologist/or whatever (more often urgent care or PCP). Usually they tell me Dr. X sent me and sometimes its obvious but not always. I personally think that if someone sends someone to the ED you should give us a call and a short run down of why. The FM resident brought up that we send people back to the clinic without a call.

I get that honestly almost every patient gets f/u with PCP in x days and those that don't get "follow up in x days if not improving". Very few get a call if any (I think you all would hate me if I called on every single patient that I discharged). If I am really concerned or absolutely need close follow up then I call (probably 1-2 patients a mont).

Honestly though I love conversations with PCP's. If they call and explain why they sent the patient over I have always done what they thought. When I have called them they seem to do the same. I am just wondering why more PCPs don't do this. If you are concerned enough to send a patient my way why not the 5 min call to tell me why?

1. In the past, when I have sent a patient to the ED, it is like pulling teeth to get to talk to a physician or a PA. At least, in this was the case in the area where I used to practice. They would always make me talk to a charge nurse, which was not helpful because the ED notes would later say "Patient does not know why he is here."

2. Where I am now, patients hate going to the ER and will almost always refuse. They always have something else that they need to do before going to the ER - "I have to pick up my kids." "I have to call my boss." "I have to drop something off at home first." After arguing for several minutes, I have them sign a noncompliance form and then let them do what they want. Sometimes they DO go to the ER, sometimes they don't. But I'm not going to call the ER for something that may or may not happen.

3. However, if that is the case, I usually write my concerns on a prescription and tell the patient to "SHOW THIS TO THE DOCTOR AT THE EMERGENCY ROOM." Who knows if they actually do.

I agree, calling the ER first is a courtesy and something that should be done.

 

[deleted480308]

In places where the ED sucks at putting a doc on the phone, would sending notes/reasoning hard copy with the patient be helpful?

 

[FrustratedFamDoc]

I always call the ED and give a heads up. It takes just a few minutes and is just the right thing to do.

 

[VA Hopeful Dr]

Agree, always call. If I have pertinent labs/imaging/whatever I will send that with the patient, I don't usually send my notes though.

I used to have my MA call to get records the next day but a) they would often refuse to release anything without a signed form from the patient b) the ED I normally send to dictates and takes 3-4 days to get transcribed and released so I gave that up.

 

[JonMonkey]

I too feel it is a courtesy that should go both ways but having worked in both an ER setting and FP setting the busy schedule often prevents, sidetracks, de-rails the courtesy calls. I make it a point to allows explain to my patients what I want to do and why I feel it is important to do so. I do send them with a copy of that days clinic note to provide. The problem that I have with calling is that I in an area that literally has 15-20 ER/urgent care centers a stones throw away and I do not always know which ER the patient will go if they do in fact go.

 

[septoplasty]

I guess this isn't standard of care..but where I did residency.. if I was going to send to ED (which would likely be the closest one, where our docs had admitting privileges), we filled out a "transfer" form and printed our clinic note, and gave the ED MD a call.. we wouldn't go as far as getting the ED notes until follow up (as we shared the same EMR, so we can just look up).

Not sure if there's a medicolegal issue with this concern though..

 

[JustPlainBill]

I always call the ED when I'm sending a patient since I personally don't like surprises myself --- the patients usually ask me to thinking it will speed up the wait time. Most of the time, the ED docs are pretty good about listening to why I'm sending them and then go from there. Where I have had pushback is from the EMS who, in our area, have decided they are actually "field doctors" and will give you a ration if they don't agree with why you're sending the patient --- that usually turns out badly for them since it forces me to pull them into a different room and go from cuddly teddy bear to rabid wolverine right before their eyes. I tend to brook no BS in situations like that. If I feel they need to go to the ER, they need to go.

 

[da8s0859q]

I always call the ED when I'm sending a patient since I personally don't like surprises myself --- the patients usually ask me to thinking it will speed up the wait time. Most of the time, the ED docs are pretty good about listening to why I'm sending them and then go from there. Where I have had pushback is from the EMS who, in our area, have decided they are actually "field doctors" and will give you a ration if they don't agree with why you're sending the patient --- that usually turns out badly for them since it forces me to pull them into a different room and go from cuddly teddy bear to rabid wolverine right before their eyes. I tend to brook no BS in situations like that. If I feel they need to go to the ER, they need to go.

Strong EMS presence where I am. If any of our paramedics pulled that bull**** with any of our community docs, I would tear into them myself. And I love our paramedics.

 

[smq123]

Strong EMS presence where I am. If any of our paramedics pulled that bull**** with any of our community docs, I would tear into them myself. And I love our paramedics.

I wish you could come work where I used to work.

I remember a patient who came in with a marked change in mental status. She was previously always totally lucid. However, this time, she answered all the MA's questions with Tuesday.

What's your name? Tuesday.
Where are we? Tuesday.
What state are we in? Tuesday.
Who's the President? Tuesday.

So we called EMS, because she was well known to us, this was NOT her baseline, she lived alone, etc.

EMS was like, "Oh, she's fine."

We had to fight to get them to transport her. And guess what? She had had a stroke and ended up staying in the hospital for a week.

 

[SqEdSaint]

It looks like some patients are sent to th ED via EMS and some asked to go on their own, which one is the best practice? I'm guessing it depends on how bad the patient's condition is. If going to the ED via EMS, can calling the ED MD be substituted by signing off to paramedics?

 

[deleted87716]

It looks like some patients are sent to th ED via EMS and some asked to go on their own, which one is the best practice? I'm guessing it depends on how bad the patient's condition is.

Correct.

If going to the ED via EMS, can calling the ED MD be substituted by signing off to paramedics?

I give EMS the same info. I would ordinarily fax to the ED (labs, EKG, copy of my note, etc.), but I still call ahead to the ED and talk to somebody.

 

[TableMD]

I don't believe in promising a test when I am sending a patient to a consult (i.e. the ED). IF I think someone has cauda equine syndrome, I would send to the ED and then call the attending and explain my concern and let them decide how to proceed. If I tell the patient that they will get an MRI, and they don't, it puts the ED in a bad spot, in my opinion.

 

[deleted87716]

I don't believe in promising a test when I am sending a patient to a consult (i.e. the ED). IF I think someone has cauda equine syndrome, I would send to the ED and then call the attending and explain my concern and let them decide how to proceed. If I tell the patient that they will get an MRI, and they don't, it puts the ED in a bad spot, in my opinion.

I do the same. I actually sent a patient to the ED a couple of months ago with that concern (first time ever). They didn't have it, FWIW.

 

[BJJVP]

I am an EM physician and while it's nice to receive a call from the PCP, I completely understand why things get miscommunicated or not relayed at all. Our group staffs several nearby urgent care centers. You'd be surprised at how difficult the communication between OUR OWN doctors has been when a patient is sent from the urgent care center to the ER. Sometimes, the patient forgets/neglects to tell us that they were literally just seen somewhere else. In addition, at any given time, the ED may have several physicians on duty. So even when one of our doctors from the urgent care center calls the ED, the actual ED physician that ends up treating the patient may not even realize what conversations have transpired. If your clinics are half as chaotic as our EDs, then I completely understand why a call to the ED would seem to be an act of low yield.

I would say that the vast majority of the time, the patient was not actually sent in by the physician. Usually, the physician was not even aware the patient was sent to the ED. Often, it was the MA or RN that sent the patient. Even then, I can almost always figure out what the concern was just from speaking to the patient/family.

To me, the infrequent but high risk situation arises when the PCP's clinical concern requires a test, procedure or consultation that isn't necessarily easy to get, but the patient has already been told to expect it. Common examples are when pts are sent to the ED to get MRI's for back pain, LP's to rule out meningitis, IVFs for pediatric dehydration, or pts sent to be admitted because nobody can figure out why they are weak/losing weight/not eating, or pts sent to be seen by a certain specialist. Believe it or not, I have to pull teeth to get non-scheduled MRIs performed, and it's even worse when I don't feel it is indicated in the first place. A lot of times, when mothers call the pediatricians' offices with complaints of fever and stiff neck, or vomiting for days, the patients get sent to the ER with expectations of CTs, LPs or IVFs. Most times, the patients are relatively well and I have am left with an uphill climb when I end up ordering very little for the pt. If the patient was sent in for me to get a third physician involved (ie admission or consultation), I am put in a very difficult position unless the admission is a slam dunk or the consultation is CLEARLY indicated. In my experience, it would be easier on me if patients were just told they needed to be seen in the hospital to make sure there isn't an emergency present.

Having said all that, I have to agree with the above poster that said:

probably our practices are a ****show and we don't have enough time to practice good medicine.

I laughed out loud at that and completely agree. I do believe that if we all weren't stretched so thin, we could do more for the patients, provide better care and even find professional interactions with each other more enjoyable.

 

[EMDOC17]

I don't believe in promising a test when I am sending a patient to a consult (i.e. the ED). IF I think someone has cauda equine syndrome, I would send to the ED and then call the attending and explain my concern and let them decide how to proceed. If I tell the patient that they will get an MRI, and they don't, it puts the ED in a bad spot, in my opinion.

I really appreciate this. I hate when patient expects X. I see a lot of ankle sprains, knee sprains,ect. and I don't ever put in follow up with your Dr. in x days if not better for an MRI. Its always follow up for evaluation. I didn't think this thread would get this much action. Our ED (in residency) makes it easy to get in touch with a physician. If they call the ED it goes out as a "physician call" meaning another physician is calling. All attendings can take these and all 3rd year residents can. Rarely does it have to be paged out twice because we actually like to take these. If another doc gets the patient they usually either come up and ask about the conversation or else look at the quick note that is required for us to write. I know you guys and gals are busy and it can be a pain but it really is good care.

 

[EMDOC17]

It looks like some patients are sent to th ED via EMS and some asked to go on their own, which one is the best practice? I'm guessing it depends on how bad the patient's condition is. If going to the ED via EMS, can calling the ED MD be substituted by signing off to paramedics?

I am not a medicolegal genius but I have moonlighted (is that a word?) in an urgent care. I had a patient with a corneal foreign body that could be removed in the ED. I didn't have tetracaine so I could not do that (I also have a rough time with these). I was more than comfortable having them drive to the local ED. Really past that I offer EMS if they refuse I document that. It is case by case on how hard I recommend EMS. R/O dvt not that hard. Chest pain with an elevated trop (we have most labs at our urgent care) I lobby much harder. If the patient has any possibility of decompensating recommend EMS. It is the medicolegal society we live in.

 

[hello1234!]

really, the fm resident commented that the ER sends people to clinic without a call... ... like really ... .. facepalm ... the difference is the acuity and level of urgency. ER doesn't need to call me when they send a pt to follow-up with PCP, bc that means the patient should be stable enough for outpatient follow-up. I'm a clinic doc and I always call the ER when I send a pt over to the ER. If it is urgent enough to send to ER it is urgent enough to call, often bc there may be something specific I want done that is urgent, otherwise it is stupid/lazy to send the patient to the ER.

 

[hello1234!]

I don't believe in promising a test when I am sending a patient to a consult (i.e. the ED). IF I think someone has cauda equine syndrome, I would send to the ED and then call the attending and explain my concern and let them decide how to proceed. If I tell the patient that they will get an MRI, and they don't, it puts the ED in a bad spot, in my opinion.

I somewhat disagree. Let's say you actually strongly suspect cauda equina syndrome and document physical exam findings that are consistent with cauda equina syndrome, in that case i will do everything I can to make sure the patient gets the MRI and stress the importance of the MRI to the patient, i'm not sending them to the ER for a consult opinion, but for a STAT test I could not get otherwise (plus I want to make sure the pt agrees to an MRI before sending them, if they refuse the test there is no point in sending them). Now the ER doc is free to disagree and not order the test, but I haven't had any issues with not getting the test done. It probably helps that I always sign out to the ER doc.

 

[BJJVP]

I somewhat disagree. Let's say you actually strongly suspect cauda equina syndrome and document physical exam findings that are consistent with cauda equina syndrome, in that case i will do everything I can to make sure the patient gets the MRI and stress the importance of the MRI to the patient, i'm not sending them to the ER for a consult opinion, but for a STAT test I could not get otherwise (plus I want to make sure the pt agrees to an MRI before sending them, if they refuse the test there is no point in sending them). Now the ER doc is free to disagree and not order the test, but I haven't had any issues with not getting the test done. It probably helps that I always sign out to the ER doc.

I see your point, and for the most part, I agree. The key, however, is that you "strongly suspect" an emergent pathologic condition is present. There are many times where one physician is more impressed with the clinical picture than another. For example, the cancer pt with known metastatic spinal lesions, who now is in severe distress, and has BLE weakness, a full bladder requiring catheterization, and no rectal tone/sensation, clearly warrants an MRI. However, last year, a PCP sent me a pt in her 60s, with chronic back pain, who had several weeks of worsening pain radiating into both hips/knees. The pt had one episode of urinary incontinence last night, and has been fine since. She arrived in the ER at 3pm. Actually, she gingerly walked in with a prescription from the PCP stating "r/o cauda equine syndrome." Other than lower back discomfort with movement, her physical exam was essentially normal. Now, I fully realize how this looks on paper. You have to at least consider a cord compression. And if this were a case on my oral boards, she gets an MRI. But, in reality, my suspicion for a true, emergent cord compression was relatively low. What actually happened? I ordered the MRI in the EMR. My nurse got a call from the MRI dept and was told the MRI couldn't be done. I called the radiologist, who was not very sympathetic. I was told that this was an outpt workup, they had a full MRI schedule, and he was not calling in the on-call tech for this. I called the spine surgeon, hoping he would back me up. Instead, he sided with the radiologist. I ordered a CT of the lumbar spine, which was unrevealing for any acute pathology. At that point, my plan was to obtain pain control, document a repeat nl exam and discharge. However, it would have been very tough for me to discharge them with some reassurance without the MRI. Ironically, hours later, I got a call back saying they somehow got room in MRI for her. The MRI was negative. The pt and her husband spent many hours in the ER, and understandably, were not very happy with me. (Disclaimer: details of the case have been changed to protect pt privacy).

The above scenario doesn't always happen. I am sure it depends on the ER, the time of day, which tech and/or radiologist is on duty, how busy they are, etc. But, at least where I've worked, this type of disagreement happens more often than many realize. I don't blame the PCPs for sending the pts. In an ideal world though, you should be able to arrange for a stat MRI from the office. Or at the very least, if this pt showed up in the ER, my source of stress should be the pt's condition, and not whether or not I can get the MRI done.

 

[deleted245139]

I somewhat disagree. Let's say you actually strongly suspect cauda equina syndrome and document physical exam findings that are consistent with cauda equina syndrome, in that case i will do everything I can to make sure the patient gets the MRI and stress the importance of the MRI to the patient, i'm not sending them to the ER for a consult opinion, but for a STAT test I could not get otherwise (plus I want to make sure the pt agrees to an MRI before sending them, if they refuse the test there is no point in sending them). Now the ER doc is free to disagree and not order the test, but I haven't had any issues with not getting the test done. It probably helps that I always sign out to the ER doc.

All I ever ask is that if a test is recommended, the referring doc is avalible to discuss it after my exam, or that the on call doc is made aware. M to F 9 to 5 I can get someone on the phone.... but inevitably, the expected MRI is on a Fri at 8pm. Sometimes people do have a suspicion, and that's cool, but if my exam is different I need to know where the concern was so we can have a good plan for the patient. And let's be honest.... plenty of docs will say "go to the ED, you MAY need an MRI', which the patient relays as 'I'm here because my doctor said I need an MRI right now!!' Its phone tag

 

[JustPlainBill]

All I ever ask is that if a test is recommended, the referring doc is avalible to discuss it after my exam, or that the on call doc is made aware. M to F 9 to 5 I can get someone on the phone.... but inevitably, the expected MRI is on a Fri at 8pm. Sometimes people do have a suspicion, and that's cool, but if my exam is different I need to know where the concern was so we can have a good plan for the patient. And let's be honest.... plenty of docs will say "go to the ED, you MAY need an MRI', which the patient relays as 'I'm here because my doctor said I need an MRI right now!!' Its phone tag

Never happens, no way, Jose.....don't know where you're practicing but never had that one...;-o

Do you ever get the idea that people use medical diagnosis/studies/conditions in an attempt to inflate their importance? Happens all the time here in DFW.

 

[hello1234!]

I see your point, and for the most part, I agree. The key, however, is that you "strongly suspect" an emergent pathologic condition is present. There are many times where one physician is more impressed with the clinical picture than another. For example, the cancer pt with known metastatic spinal lesions, who now is in severe distress, and has BLE weakness, a full bladder requiring catheterization, and no rectal tone/sensation, clearly warrants an MRI. However, last year, a PCP sent me a pt in her 60s, with chronic back pain, who had several weeks of worsening pain radiating into both hips/knees. The pt had one episode of urinary incontinence last night, and has been fine since. She arrived in the ER at 3pm. Actually, she gingerly walked in with a prescription from the PCP stating "r/o cauda equine syndrome." Other than lower back discomfort with movement, her physical exam was essentially normal. Now, I fully realize how this looks on paper. You have to at least consider a cord compression. And if this were a case on my oral boards, she gets an MRI. But, in reality, my suspicion for a true, emergent cord compression was relatively low. What actually happened? I ordered the MRI in the EMR. My nurse got a call from the MRI dept and was told the MRI couldn't be done. I called the radiologist, who was not very sympathetic. I was told that this was an outpt workup, they had a full MRI schedule, and he was not calling in the on-call tech for this. I called the spine surgeon, hoping he would back me up. Instead, he sided with the radiologist. I ordered a CT of the lumbar spine, which was unrevealing for any acute pathology. At that point, my plan was to obtain pain control, document a repeat nl exam and discharge. However, it would have been very tough for me to discharge them with some reassurance without the MRI. Ironically, hours later, I got a call back saying they somehow got room in MRI for her. The MRI was negative. The pt and her husband spent many hours in the ER, and understandably, were not very happy with me. (Disclaimer: details of the case have been changed to protect pt privacy).

The above scenario doesn't always happen. I am sure it depends on the ER, the time of day, which tech and/or radiologist is on duty, how busy they are, etc. But, at least where I've worked, this type of disagreement happens more often than many realize. I don't blame the PCPs for sending the pts. In an ideal world though, you should be able to arrange for a stat MRI from the office. Or at the very least, if this pt showed up in the ER, my source of stress should be the pt's condition, and not whether or not I can get the MRI done.

I think I agree with you completely. "Strongly suspect" is probably the most important part. The first case you present i completely agree an MRI would be appropriate and i would stress importance of MRI if it would change management for that particular cancer patient, though as the PCP i'd probably consider calling the oncologist before sending them to ER as I'd like to be able to relay the info I learned from the oncologist to the ER doc and have a good working plan set in motion. It helps that I am in a system where i can easily get ahold of the oncologist and get a response right away. If I were the PCP for the second patient with several weeks of worsening back pain and one episode of incontinence I would have ordered an MRI but I wouldn't have sent the patient to the ER. I would not have promised the second patient you mentioned an MRI if I did for some reason send them to the ER.

 

[Dr. Wexler]

Disclaimer: I'm primary care but not FM.

I will call if sending a patient to the ED. If I'm sending a pt to an ED at a hospital I have admitting privileges at I'll often phrase it as "sending in so and so, I recommend you do X and call me". Most times it goes pretty smoothly and I never get any pushback from the ED docs since I'm willing to help them dispo the pt.

If I'm sending to an ED I don't have admitting privileges at I'll send them with a handwritten note about what my concern is, any labs, and (usually) a completed office visit note. This is in addition to the phone call. I'm careful not to back the ED doc in a corner by stating certain tests or treatments are needed. On the phone I might say something like "I'm concerned for possible appendicitis" or "I think they might need a CT scan" but I don't write "r/o appy" or "needs CT scan" on the note. I'm careful not to promise the patient what the ED evaluation will consist of but I'm sure many of them think it is for special testing/treatment. If the ED doc knows what my clinical concerns are and disagrees and the patient doesn't need anything done, that's fine.

It is variable but most ED docs seem receptive if a primary care doc calls and relates a story of "this is a patient with whom I have an ongoing relationship and I am concerned they might be having a medical emergency".

 

[VenusinFurs]

I think as a pcp you will be taken more seriously if you explain what you are concerned about, and you will also get an idea if it's a waste of time to send the patient to the ed.

 

[nraesmith]

I have really enjoyed reading this thread, it is nice to hear both sides. I am an FP resident and as yet have only a couple times sent a patient to the ER. Most recently I sent a patient with concern for NSTEMI and sent her EKGs done in clinic with her. Who knows if the EMS even gave them to the ER docs (his note didn't mention it). I didn't call ahead even though I thought about it, because each of our 2 ERs have 4-6 ER docs working at any one time and I wouldn't know who to tell!

And I second the frustration about some EMS in my area. The EMS tried to tell me the lady in the story above's EKG was normal. She had an emergent cath that night and ended up in the ICU...

 

[Freezeout]

I did with the first few patients I sent over from clinic, but the ED attendings where I am are....less than friendly...so I just stopped doing it. If you're going to be rude when I'm giving you a heads up then no reason for me to call and give said heads up.

 

[EMDOC17]

I did with the first few patients I sent over from clinic, but the ED attendings where I am are....less than friendly...so I just stopped doing it. If you're going to be rude when I'm giving you a heads up then no reason for me to call and give said heads up.

Thats crazy in my opinion. Obviously different systems but where I work these calls are very welcomed. Maybe primary care and the ED have a better relationship here. I would do the same in your position if I got a rude physician on the phone.

 

[BigSib]

I call for most patients I'm sending from the office, but not if it's a straight forward situation. If I'm fielding an after hours clinic call I'll only call if there's a unique situation.

 

[cabinbuilder]

I never used to call because I hate getting attitude. However, the ER docs where I work now complained to the urgent care director so we call now, they are nice and we have an understanding.

The ONE group I WILL NOT CALL is ORTHO. It doesn't matter what state, how big or small the town. Ortho on call is THE MOST UNHELPFUL group ever. The last time a retired ortho helped me with an xray and had me call the on call ortho for an emergent injury in a child, I was told, "You obviously didn't listen in anatomy class in med school- I don't agree with your diagnosis" and he hung up on me. I splint and have them f/u or if it's bad send to the ER.

 

[jm192]

For residency purposes, the residency and ER are under the same umbrella, and thus it's policy to communicate.

At times it seems superfluous. I talk to attending X who says ok we'll take care of it. Patient gets pulled hours later after Dr. X is long gone and sees Dr. Y.
Othertimes I think it's amazing. The attendings that know me well will tell the triage people Smith sent this kid over, try to get them pulled back ASAP.

 

[Ceke2002]

I don't normally peruse these parts of the forum, but wow, this thread is both a very interesting read and somewhat eye opening as well. I don't think I have ever had a GP call ahead, or fax notes through, or leave a message with triage, or write down instructions for me to present to the triage nurse when I've been sent straight from the GP's office to the ED. Which I must admit can be rather frustrating as a patient, when you're not actually a medical professional yourself, and you're trying to sum up your GP's reasons for sending you to the ED in the first place, and the reason they gave you back in their office basically amounted to momentary stunned silence and an exclamation of 'wow, that's not normal'.

Hats off to those in the profession who day make it easier and phone ahead, or at least try and communicate your concerns with ED staff on duty in some manner.

edited to add: No, wait, scrap the 'never had a GP call ahead' part. There was one time, more than 20 years ago, when a GP did phone the ED to let them know he was sending me over to them due to a suspected Pneumothorax. Yep, one time, in over 20 years.

 

[FamilymedMD]

I'm not sure how common it is here in semi-rural Maine but I call or fax a quick note most of the time when I sent someone over to the ER. It's good for the patient and a courtesy to the ER doc. I suspect most of the time the interruption of the call is more bother than it's worth to them but I like to think it helps some of the time. My patients certainly appreciate it.