A Medical Economics Web Exclusive

How my "emergency room letter" saves times—and lives

This physician came up with a simple, cheap, and effective way to deal with those after-hours calls from the ER.

By Coolidge S. Wakai, MD
Cardiologist/Honolulu

I used to dread those after-hours calls from the ER. Because my patients like to vacation in Asia and on the mainland (I practice in Honolulu), those calls were just as likely to come in the middle of the night.

Add to that elderly patients with many co-morbidities, memory deficits, hearing problems, and a language barrier. Too often, I found myself going to the office on weekends or in the middle of the night to retrieve a medical record because I couldn't recall the details of the patient's condition and medications, or what other doctors he was seeing.

So about 20 years ago, my nurses and I designed a low-tech, inexpensive solution that I call the "emergency room letter." It's simply a brief medical record reduced on a photocopy machine to 41/2 inches by 31/2 inches so it's small enough for the patient to carry in his wallet. We also print standard 81/2 inch by 11 inch copies. We print the ER letters on bright yellow paper so they're easy to spot, and we insist that patients carry a copy at all times. We also ask that a spouse or responsible party carry another copy.

Yes, it's a crude method in this era of computers. It probably won't be long before we all carry tiny "smart cards" with microchips that contain all our medical data. And some patients already put their medical histories online, available to any physician they give their password to. But we need to address important privacy concerns before high-tech methods like these achieve widespread use. Until that day comes, we'll continue to use our bright yellow ER letters.

Included on the first sheet of the letter are summaries of the patient's pertinent medical illnesses along with the names of other physicians the patient is seeing (see the sample below). I also list the patient's current medications, as well as any drug allergies, intolerance, or sensitivities. The first page also has complete contact information for my practice (address, phone, answering service, fax, and e-mail). The remaining pages are copies of significant lab reports and tests. I also note whether the patient has a living will. What I don't include is sensitive or confidential information. That can be obtained by a phone call, with the patient's consent.

We update the ER letter during every office visit, and each new ECG or other test that we add is stamped with the current date, but we seldom need to make major changes. We don't charge patients for this service.

In the 20 years we've been using ER letters, they've been presented at countless emergency rooms, hospital admission offices, and doctors' offices. I often hear from physicians and admitting nurses how grateful they are to have this time-saving (and probably life-saving) information. ER doctors are able to initiate work-up and treatment without first waiting to locate the patient's doctor to obtain necessary information. The medical benefits to patients are obvious. Less obvious are the cost savings from reduced time in the ER.

Best of all, all of my patients have agreed to carry an ER letter, and many have expressed their gratitude. One patient, who's used the letter several times, told me, "I don't have to try to remember important information at a difficult and confusing time." Other patients have told me that their family members are also relieved that the information is available, since they usually don't know the details of the patient's illnesses, or his medications and doses, or which specialists he's seeing for which conditions.

Adobe Acrobat

To view the form in PDF, you must have Adobe Acrobat Reader installed on your system. If you do not have this free program, click on the icon below to link to the Adobe download page.

Coolidge Wakai. How my "emergency room letter" saves time--and lives.

Medical Economics

Jul. 11, 2003;80.