Patient Follow-up

One of the greatest shames in EMS is that we so often never find out what the real deal was with our patients.

17 year old boy whose parents swear he never does drugs (but did go to a concert last night) is found in his room the next day talking gibberish, reaching for objects that are not there, with poor gait, and a heart rate of 170.

67 year old female feeling weak with sudden blurry vision in one eye and in a new onset atrial fibrillation also at 170, that slows down quite nicely with cardizem.

37 year old man who fell off a ladder and is complaining of excruciating pain in his back.

I can guess that first patient was on a hallucinogenic cocktail with dust on the side, and that the second was having a stroke, and that the third fractured some vertebrae, but I don’t know for sure.

Nor do I know about any of the I wouldn’t have had a clue outcomes for patients for who I never suspected a bizarre finding.

Sure, I can bring in a cardiac arrest with ROSC in the field, and ask the EMS coordinator or a nurse or maybe the doc who had the case to look it up if they are not too busy, but I certainly can’t pester them all the time.  My best option is just checking the obituaries.

I work as an ems coordinator at a small hospital on a part-time basis and I am lucky that it is easy for me to do patient follow ups for EMS if they ask me or if it is an area I track like STEMI or stroke, or if I run across something unusual while doing charts.  I have easy access to three data bases that can tell me what happens in the ED, in the hospital, and for some of the EMS services, I can access the run form if it didn’t get left in the chart.

I try to do as much followup as I can, but I am only part-time and like other EMS coordinators, have many other duties with constant deadlines.  I think sometimes wouldn’t it be great if at the end of the week every EMT or paramedic could get a printout of their patients along with their dispositions?

The 87 year old lady who you gave fentanyl for hip pain?  She had a cracked femoral head and ended up with a new hip and is doing well.

The 75 year old lady with the abd pain you downgraded?  She coded in the ED and died of a massive GI bleed.  You’ll never make that mistake again.

The woman who screamed bloody murder every time a contraction came, and who you swore was going to pop the baby out in the elevator up to L&D?  She had a healthy ten pound baby boy six hours later.

The fat lady with the leg pain who tripped getting off the bus, who could barely fit on your stretcher?  She actually had  a dislocated knee that cut off the flow of her popliteal artery and had to be rushed to surgery when the ED staff discovered her foot was blue two hours after you dropped her off.  You sure you felt pedal pulses?

The unresponsive lady who had the seizure at church?  You were right, there was nothing wrong with her — she was a complete psych.

The man you CPAPed and gave nitro to?  He did have raging CHF.  He did well, and is back home on a new regime of meds and has sworn off eating ham.

The housewife you found passed out in her car at an intersection with pinpoint pupils and agonal resps, and who after you brought her around with narcan and swore she’d never do it again?  Well, you know, you don’t need the follow up for that one because you hear another medic talking about his call in the EMS room, and it has a ring of familiarity to it, so you say, “Was that lady a platinum blonde from New Britain with the dragon tattoo on her cleavage?”  And sure enough, it was her!

The old woman who coded on you, and you got back?  She died a week later in the ICU.  They gave her morphine and extubated her and she died twenty minutes later surrounded by 16 members of her family who loved her.

And the pretty twenty-nine year old who had a little twitch in her eye like she was winking at you, and no other complaints, you decided right there on the spot that she had a horrible brain tumor?  Surprise! you were right, and they operated and got it all in time and saved her life, and she has your picture now on her dresser and lights candles in your honor that you will be forever wise and benevolent and she will name her children after you, which she does.  No, wait, that was just a daydream while you were driving another patient on a wait and return to the wound clinic.  Didn’t really happen.  Dang it.

Maybe someday the technology will be there for us to get follow ups on all our patients, but for now, we just have to do the best we can.  Paramedics asking staff for follow up, checking back later during the shift or asking the EMS coordinator a few days later.  And staff and EMS coordinators, doing their best to let medics know when they were spot on or if they were off, telling them in a helpful way so so they can be better at it the next time.

 

3 Comments

  • Foster says:

    You’re absolutely right. We don’t grow if we don’t see the outcomes of our work. …Or at least, we’re less likely to grow in the right direction.

    You’re in a pretty good spot to change some of this in your hospital job. Why not set up a system where paramedics can flag patients they’d be interested in getting follow-up on, and then a mechanism by which they can come to your office and do some chart review with you to see what happened? Have them put one of the patient’s stickers on a index card with their name on it, and drop it in your mailbox, then all you have to do when they visit is punch the numbers into the EMR. If you’re hurting for time, why not coordinate with the medical school and have medical students work with paramedics to this end– it could be a really great bilateral learning experience (and bonus: the med student will have access to and know how to use the EMR).

    Just a thought. Glad you’re still writing, Pete.

  • A35EMR says:

    I just want to thank you for doing what you do. Your book “Rescue 471” is what inspired me to start my career in EMS. I am currently 16 and working for an urban ambulance service as an EMR, and your blog has been really insightful into skills and knowledge that any healthcare provider should have. Thank you for making a difference and for helping others make a difference.

  • Patricia Landmesser says:

    I agree with these two… thank you for writing. Your work is inspirational, entertaining and down-to-earth informative. Seems it should be a must read for any who are interested in the EMS field. Many Thanks!

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