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 and the frequency of telephone calls made between these departments about 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 in-house physician. The participants were the directors of the full time EDs in the state of Iowa. There were no interventions. The measurements and main results are as follows: 38 of 42 sites responded for a response rate of 90%. Of these, 58% keep problem patient lists and consult 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 only 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 made 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 institutions about drug-seeking patients. These practices compromise patient confidentiality but may be potentially justified in some instances. The lack of controls on access to patient information files and lack of scrutiny of information entered is of concern.