THE USE OF UNOFFICIAL PROBLEM PATIENT FILES AND INTERINSTITUTIONAL INFORMATION-TRANSFER IN EMERGENCY-MEDICINE IN IOWA

The study objectives were to determine the use of ''problem patient'' files in full-time Emergency Departments (EDs) in the state of Iowa an d the frequency of telephone calls made between these departments abou t drug-seeking patients. The design and setting were a mail survey of 42 EDs in the state of Iowa determined to be staffed full-time by an i n-house physician, The participants were the directors of the full tim e EDs in the state of Iowa, There were no interventions. The measureme nts and main results are as follows: 38 of 42 sites responded for a re sponse rate of 90%, Of these, 58% keep problem patient lists and consu lt them an average of 2.6 times per week (range, 0.2 to 7.5). Only 5% have a policy limiting access to the information in these files, and o nly 14% have any controls over the adding of information. Thirty-seven of the 38 sites reported making and receiving calls to and from other institutions about drug-seeking patients. The mean number of calls ma de is 23 a year, and the mean number received is 20 per year. Problem patient files are common in EDs in Iowa, as are calls between institut ions about drug-seeking patients. These practices compromise patient c onfidentiality but may be potentially justified in some instances. The lack of controls on access to patient information files and lack of s crutiny of information entered is of concern. (C) 1995 by W.B. Saunder s Company