Chief Complaint: "ER follow-up"
No, it's not an oxymoron.
Virtually all ER visits include as a prominent discharge instruction:
FOLLOW UP WITH YOUR PRIMARY DOCTOR.Much of the time it's a good idea; often I have no idea you were there or what happened to you, and I appreciate the opportunity to get up to speed. If it was an acute illness for which treatment was begun (say, pneumonia) a re-check is often appropriate to make sure you're getting better. If it's something more minor, like a bladder or ear infection, then it can be a waste of time (though sometimes a chance for me to discuss the role of antibiotics in ear infections, even though they're universally prescribed by ER docs.) Obviously if you've got stitches or some other wound, it makes sense for me to check it out, remove the sutures when it's time, and so forth.
But what about the role of the ER in following up with what was done there?
Despite the impression given -- especially by trainees -- of Emergency Medicine as shift work, there's always follow-up. Just because one doctor goes off-duty, there are virtually always aspects of the patient encounter that remain to be followed up later. And make no mistake: ER follow-up is as vital to good medical care as it is to risk management (AKA not getting sued, or, more cynically, making sure the inevitable lawsuits are as defensible as possible.)
Any time you do a test that doesn't provide a final result prior to the patient's discharge, someone has to be responsible for following up. Making sure the results are back, taking note of what they are, and contacting someone -- patient, primary or other consultant -- is part and parcel of ER care.
Oh no, I hear you cry. We never discharge patients until we have all their results. Really? You mean you never send a urine, blood or CSF culture (not just rapid antigen tests) from the ER? You can't make bacteria grow any faster, you know. You really keep people in the ER for 48-72 hours, just waiting for cultures? You've never sent out a serologic test for Lyme or anything else? Or does every single one of you work in an enormous medical center where every possible test is run on site 24/7? Do you not have radiologists reading your films on a backup basis, and have they never found something you missed? It's appropriate -- and often vital -- to send these tests from the ER, but it's just as important to make sure the results come back, are noted and disseminated to the appropriate parties.
There are many ways to accomplish this, but ideally it needs to be systematic. Keeping track of (and tracking down) results can be delegated to clerical staff, but review of results should probably be done by physicians or nurses. During an ER rotation I did at CHOP during my residency, the job was assigned to one of the senior residents each day. (That's why they were always yelling at us to get phone numbers from parents, that often didn't work anyway. Things may be a little better now in the cell phone era, but I'll bet not by much.) In one small-ish community hospital I know, the chief of the department comes in on a day (not middle of the night) he's not working a shift and goes through them. (That's the guy who called -- during office hours -- about a concern with a patient seen earlier.)
There are good ways and not-so-good ways to handle this issue. At my current hospital, the policy is only to call patients back with sent-out test results if they're positive. I think this is a terrible idea. My patient was frantically calling me for her Lyme result. That's the only way I found out about their policy and believe me, I'm going to be calling someone about it.
So to all you ER residents out there, although you may not be involved with it or see it happening, and even though it's not nearly as sexy or exciting as actually moving the meat, following up on cultures and send-outs and unexpected radiology findings is part of the job. Being in training gives you the luxury of imagining that once you dispo the patient your responsibility is over. It's as naive as an FP or IM resident saying, "I just want to practice medicine, and not be bothered with the business aspects of practice." Don't kid yourself.