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Wrong patient phone numbers trip up ER docs

The phone numbers and address the man gave two weeks ago to the University of California, Irvine, Medical Center emergency department turned out to be wrong, so when results of a blood culture came through the day after he was discharged, several phone calls and an urgent visit by city police weren’t enough to track him down.

“There is no way to find the patient,” fretted Dr. Michael J. Burns, a UCI emergency room doctor who fears the infection could spread to the man’s heart or joints. “If he came back, we’d admit him.”

It’s a scenario becoming more common in emergency departments across the country, where doctors from Connecticut to Colorado say they find themselves desperately seeking patients with potentially serious or life-threatening illnesses and injuries.

A combination of delayed test results and bad contact information — sometimes from fearful patients who deliberately give fake names and numbers — is forcing some emergency room officials to resort to people-finders, registered letters and law enforcement visits to deliver their diagnoses.

“This is an extremely common problem for patients of all ranges of ages,” said Dr. Michael Carius, chairman of the emergency department at Norwalk Hospital in Norwalk, Conn. “I think it is getting worse.”

No one keeps regular statistics on wrong patient phone numbers in emergency rooms, or whether they’re caused by patient or clerical error. A 2000 study of 1,136 patients published in the Journal of Emergency Medicine found that only 42 percent could be successfully contacted using the numbers provided. Nearly 28 percent of the patients gave wrong or disconnected numbers, researchers found. The rest were not home or did not answer and couldn't be reached.

Carius estimates he encounters the problem once or twice a week. Other ER doctors say it’s more rare than that, perhaps once or twice a month, but most agree that it’s a dangerous trend.

“People don’t understand that it does threaten your safety,” said Dr. James Feldman, an associate professor of medicine and research director at Boston Medical Center’s Emergency Medicine department. “It’s vital to have the most accurate and reliable way to contact them, in an emergency department more than any other department in the hospital.”

Sketchy cell phones, patient fears

Short-term cell phone contracts, declining use of landline telephones and patients who fear big bills or checks on immigration status all contribute to the problem, said Dr. Jeffrey Sankoff, an emergency physician at Denver Health Medical Center.

“People have various reasons for not providing accurate information, some legitimate, some not so much,” he said.

The typical situation involves a patient who arrives in the emergency room, undergoes tests and seems well enough to be discharged.  But some tests take a day or two to complete and when the results come back, doctors realize there’s something to worry about.

“Sometimes it can be an X-ray that’s looked at the next day and someone sees evidence of bleeding on the brain,” Feldman said. “Fractures are found on readings when they’re reconsidered. I’ve definitely known kids who’ve had positive blood cultures.”

Doctors will try to contact patients using the numbers given, but if that doesn’t work, they’ll step up the efforts, using reverse search directories or calling neighbors. “I’ve tried everything. You really have to be a good detective,” said Dr. Kristi L. Koenig, director of health preparedness for UCI.

If the problem is not too urgent, doctors will send registered letters to patients' homes. If the situation is more serious, experts turn to paramedics or law enforcement, as Dr. Perri Klass, a New York pediatrician, described in an essay about tracking patients in a recent issue of the New England Journal of Medicine.

“I've sent the police out to find a newborn who screened positive for hypothyroidism and to find a toddler whose lead level was off the charts,” wrote Klass, a professor of journalism and pediatrics at New York University.

‘There was no way to locate him’

In the case of the missing UC Irvine patient, the man came to the emergency room the week of April 13 complaining of abdominal and back pain, Burns said. He was a longtime Vietnamese immigrant who suffered from short bowel syndrome, a condition caused by previous intestinal surgery. He also had a catheter in his arm to deliver liquid nutrition and antibiotics.

The on-call doctor treated the man for infection and pain and took X-rays and CT scans. When they appeared normal, the man was deemed ready for discharge. “He seemed OK, he was responding to meds,” Burns said.

It took a day for a blood culture to come back from the lab, and when it did, it showed evidence of an infection caused by the catheter in the man’s arm. Ideally, doctors would have removed the port, Burns said.

But calls to two listed phone numbers were answered by people who said they’d never heard of the man. That’s the same answer police officers got on April 13 when they went to the listed address, said Capt. Kevin Baker of the Westminster Police Department.

“He gave a very common Vietnamese name, so there was no way to locate him,” Baker said.

Such situations are frustrating for doctors, who aren’t able to provide the treatment patients need.

“Even if it’s not the provider’s fault, it’s really a failure to perform to the standard of care,” said Carius, the Connecticut doctor.

In some cases, however, critics argue that delayed diagnoses in the ER are actually medical errors and that some doctors don’t try hard enough to reach seriously ill patients. In Connecticut, lawyers say a 74-year-old woman died after emergency doctors failed to properly diagnose an abdominal perforation and sent her home. When they realized the problem the next day, they called the woman’s house, but didn’t get an answer. She died shortly after.

“One of my experts said they should have sent the police,” said Kathleen L. Brandt, a Stamford, Conn., lawyer representing the woman’s family. Brandt is a member of the lawyers' network

At least one patient tracked down by police after leaving a Veterans Affairs urgent care center found the experience unnecessary. The patient, who posted an account on the website, suffered from a staph infection and other ailments and left the emergency room after becoming nauseated during a long wait. At 2:30 a.m., there was a knock on the door.

"Told the policeman I had a staph infection and he backed away," wrote the poster, who confirmed the experience to, but did not want to be identified. "Told him I would see my primary care provider in the morning and that I could not believe they sent the police."

Patients bear responsibility

Some doctors say they find it ironic that it’s more difficult to contact patients even as society’s modes of communication have increased.

“The whole event evoked for me this feeling you get sometimesin primary care of tossing your patients out into a strangeand anonymous sea, and watching them sink out of sight despitethat ever-growing criss-crossing net of connections,” wrote Klass, the New York pediatrician.

Burns, the doctor who tried to track down the Vietnamese man, said patients must cooperate better in their own care.

“Personally, I don’t feel badly,” he said. “He had a responsibility to give accurate information. It’s not the medical system’s fault. It’s his problem.”

Raising awareness about the potential dangers of giving inaccurate information may be the best solution, Feldman said.

“I don’t think patients know the seriousness of having good contact information. Your visit doesn't end when you leave,” he said, adding later:

“At the end of the day, you really have some opportunity to prevent a disaster.”