10 September 2008

Paperwork in a paperless system

We finally transitioned to electronic patient reports earlier this year, the so-called "paperless" system. The old system involved a single, legal-sized sheet, with 3 carbon copies attached. Patients and facility staff signed the back of the top sheet for all the legal and billing junk. We left a carbon in the patient chart, a carbon in a mysterious box that was supposed to go to the state, and one carbon and the original back to the station for billing and whatnot. Transitioning to the computers was not a challenge though dislike the software because I think it is a disorganized muddle of patient information. Somehow the printed version of it which is faxed to the hospital seems reasonable, but trying to figure out which window had which aspect of patient information was an annoying hurdle when it could have been an intuitive breeze.

The Asian and I have a system that makes us very efficient in turning over emergency calls. The person in the passenger seat starts the computer form with the dispatch information like address, dispatched complaint, which fire engine is responding, etc. while we are rolling to the call. (This takes second seat to helping the driver navigate, if needed, but usually the driver is fine until we're pretty close to the call and the computer work is done by then.) On arrival, one of us starts entering info like patient medications, medical history, date of birth, vital signs from the firefighters, basically as much as we can get and still deliver efficient patient care. Anything that doesn't get entered on scene usually gets entered on the way to the hospital, leaving only the billing information, signatures and narrative to write at the hospital.

Transfers are a slightly different beast. We use the same software, but not everything can go into the computer. There is a separate form for EVERY transfer that involves somebody from the hospital certifying that it is medically necessary for this patient to transfer by ambulance. This form has been the source of a massive number of headaches since just before the transition to the computers. Now we are being told that the crews have to make sure everything is accurate on the form, which we are not allowed to write on and not allowed to make changes to. Rarely, this form is filled out by the MD which saw the patient and is never available for questions/changes at the time of transfer. More often, this form is filled out by a "discharge planner" who may or may not be an RN and may or may not actually read the form prior to randomly checking boxes and signing the bottom and is rarely available for questions/changes at the time of transfer.

First, the crews were the ones taking the brunt of staff resentment at having to fill out this stupid, unclear form and having to tell them either they fill it out or we're not taking the patient. Finally, enough issues were addressed that staff just accepted our form as another hurdle to getting the patient out the door. Crews were told that we just needed to accurately document the patient's condition in our narrative and billing would address the inconsistencies. Now, the crews are the ones who are going to have to point out that to the staff any inaccuracies in documenting the condition of the patient. "So the patient is bed confined?" "Yes." "Then why is he sitting in a chair having lunch?" "!*@#$%, I didn't fill out the form and I'm not going to fix it."

Good to know everything poo-related still rolls downhill to the crews. It isn't enough to be polite to facility staff, kind and caring to your patients, take appropriate medical care of them, and document observations and treatments accurately. Now, we have to find the political savvy to point out that their paperwork is wrong without causing any offense. This will certainly be easier for some crews and with some staff than others.

1 comment:

manchmedic said...

Politics? We don't NEED no stinking politics! Besides, it's sooo much fun to watch the hospital staff sit and spin.....