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Mon Jan 12 14:31:33 GMT 2009

Dr. Sclafani's are among the more reasonable and compelling reasons for
radio logic restraint at the primary hospital phase; but there are also
a host of practical, systems-related incentives to defer the scans to
the Trauma Center, starting with the fact that many of these facilities
have a seductive and wholly distracting ability to identify injuries
they can't begin to treat. 

Especially in the context of major injury, community-hospital CT (and
indeed most plain radiography) is functionally low-yield, inefficient,
and problem-prone.  It should be systematically discouraged.

See also VOMIT and BARF syndromes.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Rob Smith
Sent: Sunday, January 11, 2009 10:44 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: reimaging transfer patients

Great stuff. The list at its' best. You completely turned my head around
from my original thoughts on this.

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of sjasmd at aol.com
Sent: Sunday, January 11, 2009 9:34 AM
To: trauma-list at trauma.org
Subject: Re: reimaging transfer patients

The issue is far from clear to most people, there are nuances, legal and
otherwise which have not been elaborated in this discussion.

There are many considerations when reviewing images performed at another
hospital. Some are clinical, some are medicolegal, some are legal.
radiologists have to assure that we are HIPPA compliant. we have to
assure
that the images do belong to the correct patient, They must reach our
own
standards for quality, and we must record our impressions in our own
medical
record.

1. there is always some concern regarding whether the images belong to
this
patient. We do not have any way to verify this in a pacs environment
because
all the demographic data is digital and is not on the image when it is
taken,

2. The images must be read in the context of our own standards: contrast
bolus given appropriately or at all? coverage of area of interest
sufficient? etc

3. "hallway" consults are not satisfactory or standard of
care.?radiologists
are legally?at risk for any hearsay comments the surgeon writes about
the
curbside consult. ?A documented reading by a radiologists must occur for
his
or her own protection. ?Many electronic radiology departments report via
voice recognition into fields in the electronic medical record. That
means ,
in our system, that someone must put an order for the test into the
system.
The system is so intertwined with billinlg that reporting risks being
re-billed and that is problemlatic and potentially fraudulent. Sometimes
an
order is placed in a system and someone in radiology actually performs
the
test.? I resolve this issue by writing a consult in the EMR rather than
creating a radiology report. Problem is, many times the referring
physician
looks in the radiology part of the record and never finds my opinions.
(neither does risk management). 

4. some insurers will not insure for curbside consults.

5. "peeking" into another hospital's electronic medical record is
possible
just as it is possible to break into someone's home and read their
email. We
create firewalls etc to protect ourselves. so do hospitals try to
protect
themselves and their patients. Most "peeks" between hospitals that
writers
have discussed? are based upon written agreements WITHIN a medical
enterprise, not between medical enterprises. 

In new york state, we are trying to create consortia of hospitals that
will
share medical records. We are some distance from the finish line

sal

sal

-----Original Message-----
From: Fiona Wallace <tielserrath at yahoo.co.uk>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Sat, 10 Jan 2009 11:05 pm
Subject: RE: reimaging transfer patients

We are electronically linked to our nearest referral hospital and they
can
view all our radiology.
For referral elsewhere we email the relevant images. 

Our imaging department is in the process of moving to a web-based system
which can be accessed from anywhere; this will be the logical answer in
the
future as all you need then is a fast internet connection.

The CTs I have seen on CDs carry a small software program that loads
first
to enable you to read them. The main problem is when an officious IT
department puts an administrator block on the computers so the software
can't load.

If there are going to be serious issues we download as .jpegs, which are
an
utter pain to read I know, but better than nothing at all, especially if
sent with a note highlighting which slices match with the major
pathology.

Could OSIRIX get round this?

Fiona Wallace
Tasmania

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Joe Nemeth, Mr
Sent: Saturday, 10 January 2009 9:41 AM
To: trauma-list at trauma.org
Subject: RE: reimaging transfer patients

Happy New year to all!

A quick one:

What do people do regarding transferred patients coming in with imaging
on
CD and radiology refusing to read (cannot double dip, hence no pay,
hence no
read)...

Do you rescan the patient only to have it now read by the happy
radiologist?...
Read the imaging yourself?...
Do you have a system in place where imaging from outside can be accessed
by
your own radiologist, i.e. function on a same database system?...

thanks,

Joe 

Joe Nemeth MD CCFP EM
Director,
Dept. of Emergency Medicine
Montreal General Hospital
Assistant Professor
Pediatrics
Montreal Children's Hospital
McGill University Health Centre

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Subject: trauma-list Digest, Vol 67, Issue 9

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reimaging transfer patients