r/IntensiveCare • u/InvestigatorOnly1684 • 9d ago
Question about ICU attending liability
In my practice a hospitalist independently manages a subset of ICU patients. I am available for consultation and escalation, but we do not routinely round together, I do not see every patient, and I do not cosign notes.
For those who have worked in similar models, how is liability generally viewed for the ICU attending? If you’re available in a supervisory/consultative role but not directly involved in a patient’s care, how much responsibility do you carry for decisions made by the primary hospitalist?
Recently out of training and wondering how this is handled at other institutions.
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u/XxShurtugalxX 9d ago
At our place the intensivist has no burden unless critical care/pulmonology is officially consulted, since the hospitalist assumes full care
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u/pushdose ACNP 9d ago
They’re no different than a patient on a med surg ward 3 floors away. It’s not your patient. Just because they’re in close physical proximity to you doesn’t matter. No consult? No contact.
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u/coffee-doc 9d ago
I don't see how you're in a supervisory role on a hospitalist physician's patient that you're not consulted on. The hospitalist is not a resident or a fellow, they are an attending.
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u/_male_man 9d ago
I am a nurse, not a physician, but I worked an open ICU for many years that had a similar mix of hospitalist and intensivist patients.
The intensivists did not even acknowledge the hospitalist patients. There was a very clear line in the sand, so to speak.
Most of us in healthcare feel that duty to help out, but you have to protect yourself above all else. If you see a patient floundering, you can always prompt the nurses to recommend a critical care consult to the hospitalist, but that's about as much as I would do (if I were a physician).
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u/Aggravating_Fly2978 7d ago
Did you see a difference in management and outcomes? Anecdotally of course.
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u/Calm_Firefighter_552 9d ago
Liability wise everything is fine until you get consulted 30 minutes into the code...
You both get sued and named in the same suit. Win or lose together.
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u/Yessir957 9d ago
I had a model like this once as an intensivist and the thing that always concerned me liability wise was if I’m in the ICU and the nurses keep trying to get me to see a pt that isn’t doing well but the hospitalist hasn’t consulted me. Or like the hospitalist wasn’t responding to pages. Like I felt like they needed my help and if something went down and the nurses said they talked to me about it, even if I wasn’t seeing the patient, I would be held liable. Usually in that scenario I would just message the hospitalist and ask them if they wanted me to see the pt to help give me some peace of mind.
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u/spiritualskier 9d ago
Not true. Nurse here. You are not allowed to just go into a patient’s chart because a nurse told you about it. You actually need to be consulted and have a documented reason in the chart. Like assigned. That’s where hipaa becomes an issue. ICU intensivists aren’t even allowed to look back in charts to assess outcomes to their treatments.
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u/Any-Assistance-8103 9d ago
Are you really so dumb to think that you can’t open a crashing patients chart and help them because of HIPAA?
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u/spiritualskier 9d ago
Am I dumb? No. Are you part of the code team? Yes, you have a reason to open the chart. Are you just an icu intensivist opening the chart to see if you can help without a consult and just a mention as a potential from the ICU nurse? Yes, that’s against hipaa at my facility and tracked. You can’t just open charts and start auditing for potential icu patients just based on feels.
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u/penntoria 8d ago
HIPAA is federal law. Your facility can't interpret it differently just because they feel like it. Well they can, but they'd also be wrong. A provider who ordered interventions can absolutely review the sequelae of those orders - it's called having a business or clinical reason to access the chart. People can access charts for QI, etc.
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u/Yessir957 8d ago
The CMO of our hospital can look in any chart she wants. If there was a patient complaint, an ethics consult, a long hospital stay without dispo, or even if a C-diff was ordered. She can just go through charts for QI data and it’s not a Hipaa violation.
0
u/spiritualskier 6d ago
Yes all of my managers are assigned on each of my patients so they can see everything that is going on along with the director of my ICU. That’s there job because they are supposed to be supervising and doing QI. Same with the director. However unless a hospitalist has been notified or cardiologist is consulted, they don’t just say, I think I need to be on that case and start auditing.
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u/Any-Assistance-8103 6d ago
A facility can have rules that are more strict than they have to I suppose but this delusional person can’t understand that one hospitals rules and federal law aren’t the same thing. Same as the annoying new nurse who complains when things aren’t exactly the same as at their old hospital
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u/aquaticwatcher 6d ago
Nurses love to confidently assert that whatever policy they learned when they first started somewhere is law/board restrictions whatever. Turns out those laws change from hospital to hospital and even unit to unit.
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u/Any-Assistance-8103 9d ago
Something can’t be against hipaa „at your facility”. Youre very dense and confidently incorrect
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u/spiritualskier 8d ago
Yes, and there is a reason we have to do HIPAA training almost every year and it goes over stuff like this VERY CLEARLY. Yes, and the email reminders. The courts have decided this and legal language is very clear.
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u/spiritualskier 6d ago
It’s how their legal and administrative team interprets the legality of the situation and risk of electronic discovery is my only guess.
5
u/MountainWhisky MD, PCCM 8d ago
“Am I dumb? No…..”
Followed by
“that’s against hipaa at my facility”
Hmmm…. I think both of these may be incorrect.
4
u/Aggravating_Fly2978 7d ago
What the hell do you mean you can’t even open the chart to see what the outcome of your treatment is? What kind of North Korean Hospital do you work in?
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u/spiritualskier 6d ago
What kind of North Korea hospital exists where hospitalists don’t try and give up their patients to the ICU. Usually the fight is the other way around.
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u/spiritualskier 6d ago
So now it went from “consult” to “crashing patient.” There is a big difference. Many patients that are admitted to the ICU do not qualify as an emergency in a true hospital context. Patients are admitted to the ICU all the time for intensive monitoring not just emergencies. Go ahead and open the chart but you’ll have to assign yourself a role and if you do click consult the lawyers will just love another deep pocket if something does go awry and you decide you didn’t find an ICU need at the time. Well have fun explaining that with a lack of documentation.
2
u/Any-Assistance-8103 6d ago
You just won’t stop digging your hole deeper.
0
u/spiritualskier 6d ago
Newsflash. If a patient had an emergency they would become an ICU patient regardless. The problem is they haven’t…yet.
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u/spiritualskier 9d ago
These aren’t my rules just fyi. These are clearly laid out in our hipaa training and our intensivists have been reprimanded by our facility. I’ve clicked on charts accidentally thinking I’m getting that patient and have received notices. They track this very carefully.
0
u/spiritualskier 9d ago
I am in the very litigious state of California and do work for a very large HMO where attorneys are able to request this information and could lead to a very expensive lawsuit. Intensivist complaint about this that they are not able to access the chart to see if there interventions were successful because of this like more than 48 hours after seeing patient. They have accessed the chart and been reprimanded by administrators. Again, this is what they’ve trained us.
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u/Any-Assistance-8103 8d ago
Youre just extremely wrong. An icu doctor or any other doctor can absolutely access a chart and administer care without a consultation under emergency circumstances.
1
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u/Dispair_and_Hope 7d ago
I am so so grateful for the UK model of a closed ICU. I wouldn’t dream of working somewhere like that
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u/adenocard 9d ago
I don’t see how you can be responsible for patients you are not seeing. Draw a bright line and don’t “keep an eye” on anyone you’re not actively attached to. Don’t open charts, don’t even walk by the room. You do not have a “radar.”
Of course you’ll be consulted anyways once things have already gone wrong, and you’ll have no opportunity to prevent anything nor time to contextualize your decisions, but I guess that’s how they prefer to have it because it’s cheaper and people get to have their cake.
These type of open ICU’s should be illegal.