List Archives

Sat Aug 19 05:08:03 BST 2006

Why do members of trauma teams continue to add to the futile list of unnecessary labs on so called trauma panels? Certainly if a test is indicated, it should be done.  However, collecting a BAL on an alert, oriented, appropriate pt with no clinical indicators ranks right up there with CBCs on MVA patients complaining of ankle pain.  Priceless...no,  Useless...yes.  What do you do if a pt has a BAL of .09 and wants to leave AMA? In Texas a BAL of .08 is neeeded for DWI.  But guess what, the patient is not driving home if they totaled their car on the freeway.  It's illegal for them to drive, not walk.  Certainly it is preferable to release the pt to a family member.  There is not a law in the nation that allows a physician or nurse to restrain a patient based on their BAL level.

      Another issue of a blanket policy advocating BALs on trauma patient involves billing fraud.  Ordering and billing for a laboratory test that is not clinically indicated or have a diagnostic value may constitute fraud.

      And not trying to throw stones but you stood up in the middle of the firing range.  Since when (and why) does a clinical nurse have access to resolution of patient billing (CAN WE SAY HIPPA VIOLATION) that is resolved usually weeks after the patient is discharged.  Billing is the responsibility of the business office, not the ER registration clerks.

-----Original Message-----
From: bensonblues at comcast.net
To: trauma-list at trauma.org
Sent: Fri, 18 Aug 2006 7:05 PM
Subject: Alcohol Screening (revisited)

Drug and alcohol abuse and trauma are very closely linked. If folks in Detroit 
would drink responsible and stop using crack cocaine, from my estimate, the 
trauma case list would be reduced to little old ladies with fractured hips (and 
occasionally these girls have had a nip of brandy prior to their fall).

I am not opposed to mandatory screening in trauma patients (Level I, II, or 
III), but the question remains: What to do with the data, other than use it for 
medical care.

In terms of intervention, we don't have the resources. I suspect that the only 
coucelling they get is from me, telling them that they might want to rethink 
their vises and behavior - as the surgical team takes them off to the OR. They 
are seen by Social Work postop (who are over-worked, understaffed, and 
underpaid), but the best that the law allows (unless they are being charged with 
a crime) in terms of intervention is referral to outpatient services - which 
will usually only see them if they have insurance.

I recall a study done in Baltimore many years ago. They screened trauma victims 
for EtOH and drugs of abuse and found (as I recall): a majority of victims had 
EtOH and another substance on board, followed by EtOH only, followed by nothing, 
followed by marijuanna. In other words, in terms of being a trauma victim, you 
were more likely to be a victim if you were straight than if you smoked pot. 
Obviously, we don't encourage our patients to toke down as a way of avoiding 
becoming a trauma victim. But, this illistrated the problems interpreting data 
obtained by dredging patient records.

DB
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Alcohol Screening (revisited) and HIPAA