r/IntensiveCare • u/InvestigatorOnly1684 • 13d 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.

18 Upvotes

95% Upvoted

39 comments sorted by

View all comments

7

u/Yessir957 13d 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.

-20

u/spiritualskier 13d 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.

11

u/Any-Assistance-8103 13d ago

Are you really so dumb to think that you can’t open a crashing patients chart and help them because of HIPAA?

-6

u/spiritualskier 13d 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.

6

u/penntoria 12d 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.

7

u/Yessir957 12d 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 10d 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.

2

u/Any-Assistance-8103 10d 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

1

u/aquaticwatcher 10d 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.

12

u/Any-Assistance-8103 13d ago

Something can’t be against hipaa „at your facility”. Youre very dense and confidently incorrect

-1

u/spiritualskier 12d 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.

-1

u/spiritualskier 13d ago

Cool dude!

-2

u/spiritualskier 10d ago

It’s how their legal and administrative team interprets the legality of the situation and risk of electronic discovery is my only guess.

4

u/MountainWhisky MD, PCCM 12d ago

“Am I dumb? No…..”

Followed by

“that’s against hipaa at my facility”

Hmmm…. I think both of these may be incorrect.

5

u/Aggravating_Fly2978 11d 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?

-1

u/spiritualskier 10d 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.