Repetitive Transport Documentation- Consistency is Important
The Same Patient
Repeat patients often suffer from chronic illnesses that persist during a period of their life span. Some patients never escape from their condition and others, thankfully improve to the point that they no longer require ambulance transportation.
Because we interact with these patients, day in and day out, we gain first-hand knowledge of their underlying medical problems. The disconnect comes, though, when we don’t pass that information along in a systematic fashion to our fellow EMS providers.
Baseline
Every patient we transport has a baseline medical condition. It may be that we are hypertensive, we could have asthma, some of us may have had an acute attack such as a past heart attack or stroke.
These baseline conditions may be visible or not visible.
If a patient has decubitus ulcers today, it’s not likely that those ulcers are going to magically disappear tomorrow or even next week when we transport him/her.
Missing Key Information
So the problem for EMS comes when we do not consistently document a repeat patient’s condition with the underlying conditions every single time we transport that patient.
Now, we strongly advocate against scripting.
No ambulance administrator should ever dictate the exact words that any EMS provider “must’ include in their written narrative. All written PCR narratives must be an independent set of facts derived from a hands-on patient assessment at the time of the transport. The provider paints a picture in words concerning the patient’s medical necessity and the reasonableness of the trip at the time of the transport for each and every transport.
But, key information that is derived from the patient’s baseline must carry over from one transport to the other.
There is absolutely nothing wrong with preparing a “file” of information for our repeat patients that providers can pull and review to remind them to look for and ultimately include those conditions in the written PCR narrative.
Burden of Proof
Of course it’s incumbent upon the provider to review the underlying conditions and verify when transporting that they still exist for the patient.
Returning to the contractures example, the patient file can remind the provider prior to taking the transport of all of the patient’s baseline conditions – of which would certainly include the joint contractures. The EMS provider then would assess the patient to confirm the existence of that baseline condition and be sure to include the finding as part of his/her assessment documentation.
How can that be?
This billing office has seen the success of this model but we’ve also seen the failures too.
On the failure side, we have seen documentation for the same patient on the same day contain one medical necessity explanation for the trip to treatment and a completely different medical necessity word picture painted for the return trip from treatment back to the facility of origin.
How can that be?
On the initial trip, the PCR author documents that the patient is bed bound due to contractures and is unable to be transported safely by any other means. On the return trip, the documentation includes no mention of contractures listing just vital signs and a description of how the patient was moved.
Did the contractures miraculously disappear in the space of time between the first leg of the round trip and the return trip?
Had this particular EMS agency come up with a means to consistently share information, the two crew members who authored the PCR documentation for each leg of the round trip would have been aware of the need to consistently document the underlying medical necessity status of the patient. Each provider would have been looking for and subsequently documenting those baseline conditions by incorporating their assessment findings into the narrative written for each leg of the trip
Consistent Communication = Consistent Documentation
Consistent documentation will happen when there is consistent communication amongst your street staff. Staff meetings, briefings and systematic information sharing of patient chronic conditions must be employed on a regular basis. If your EMS providers are aware of what to look for and what the expectations are for their PCR documentation, then they’ll be consistent with documenting those patient conditions that carry over from one transport to the next one.
