The Grunt Doc reports that he is encountering a new strategy when Nursing Home patients are transferred to his care. They come with the list of medications but no record of when these dosages were last administered to them.

When they’re my patients I now ask for a faxing of the patient’s MAR from the nursing home with the removed information included, because it is, you know, part of the medical record, and may well be useful in the diagnosis and treatment of the patient. A patient often sent in with “AMS” (altered mental status) as the one-line explanation for the transfer, and the patient is on several (usually more than a dozen) medications, at least a third of which could cause an altered mental status. It would, in that case, be nice to know if they got their regular, let alone their PRN (as needed) sedative(s), as well as all their other medications.

The kicker is, since I cannot determine when their medications were administered (because the times were cut off of the copies sent to the ED), a lot of very useful information is now denied to me, the ED physician, and then most likely to the admitting team, since none of us can say who got what medication, and cannot account for their altered mental status. (I’m using AMS as the example here, but there are other complaints that could be medication related).

This intentional removal has happened often enough ( from different nursing homes and at different ED’s) that it’s clearly part of an organized effort on the part of Nursing Homes. I’m at a loss to think of a single innocent reason why this practice would have started. When I’ve called personally to have the information faxed (for patient care, the reason they sent the patient to the ED) the Nursing Home nurses routinely say that “It’s policy”, and then sometimes send the information, and sometimes they don’t.

The comments at the post contain some pretty heated discussion about nursing homes and their quality. I don’t know that this is really a story about medical malpractice and tort reform issues as much as it is simply about medical malpractice. Obviously, there is a group that is concerned about liability, but I don’t know if it is because of unreasonable lawsuits or because some nursing homes are cutting corners. Check out the conversation and decide what you think.

In other news, the medinnovationblog posts an entry reporting that a clinic has named a doctor a “CXO,” or Chief Experience Officer.

The Cleveland Clinic has named Dr. Bridget Duffy as its first chief experience . a new role aimed at making sure each patient has a high-quality expererience that meets their medical, physical and emotional needs.

As a leading healthcare provider, we must exceed the expectations of those we serve, offering compassion, showing empathy and passion for patient-centered initiatives,” said Dr. Toby Cosgrove, the Clinic’s chief executive, in a written statement.

Duffy, who most recently was a health-care consultant and advisor in San Francisco, is known nationally for building health-care environments that treat the whole person, humanize the delivery of medical technology, and support the role of doctors and nurses as leaders in patient care.

I think this is good to the extent that it shows doctors trying to increase communication. A lack of communication can lead to litigation. It also might be needed to keep everyone focused on patient care rather than getting by. Internal quality control is a good thing. Given the expense that such a new officer might involve, I hope this isn’t simply due to medical malpractice pressures that are more severe than they ought to be.