I wonder if this is what a friend’s husband (ER doc a few states away from here) was talking about - he said that there are policies by which they have to provide pain relief w/in a certain amount of time to someone coming in complaining of pain, because of some standards they’re supposed to meet - even though it does mean that some seekers get goodies when they would otherwise be turned away.
Oooh - this reminds of of a question, which relates back to the tale I’ve related before (fall while on vacation, went to ER with suspected broken elbow, “nope, not broken”, but a later X-ray said “was too!”).
That same friend’s husband suggested that I should communicate that information back to the ER I went to on vacation. Now, as it turns out the break I had would have been treated exactly the same - sling and painkillers - so no harm was done, and the break happens to be one that’s tough to spot on X-ray anyway, so I wasn’t upset. But I do wonder if that would have been appropriate - to drop them a letter and say “FYI - tough-to-spot break, might be useful practice to review those X-rays as a learning experience”.
Have you ever heard of people contacting hospitals like that? And if so, would it have been viewed as helpful? annoying? threatening? some combination of the above?
He’s probably talking about the recent CMS (Center for Medicare/Medicaid Services) mandated “quality” measure requiring narcotic pain medications to be administers within 60 minutes for all long bone fractures. That’s arms and legs. There are very few ERs which can reliably obtain and interpret X-rays that quickly, so to meet the guidelines you have to give pain medications immediately on the off chance someone actually has a fracture.
It wouldn’t be a problem to provide feedback as long as you make it clear you aren’t upset or expecting some sort of compensation. Occult elbow fractures should be a well known possibility in the setting of negative initial X-rays. The original xray probably was normal, except sometimes it will show swelling which may be a marker for occult fracture. I typically apply a splint or sling and ask the patient to follow up for repeat imaging in one week.