CURES Act Update and Helpful Hints

March 12, 2021 9:35 AM | Deleted user

Barack Obama signed the CURES Act into law in 2016.  This 996 bill has many provisions that can be found online through ACEP, and also through HHS. This Act impacts Emergency Physicians in a number of ways and a brief review of the bill may be worth your time. 

Throughout the past year, our institution has changed the default setting to share all emergency physician notes with certain exceptions.  This action has resulted in a handful of patient complaints or requests to change the medical record. 

Here are some helpful hints that I have found through review of patient concerns. 

Common Documentation or Pitfalls

Considered Revision

Patient is obese

Patient’s BMI >30 or meets the medical criteria for obesity.

Patient refused admission to the hospital

After discussion of the risks and benefits of hospital admission the patient elected to continue treatment as an outpatient.  Patient is decision and understands they are at increased risk of myocardial infarction….  The patient is concerned if they are admitted there will be nobody to watch their children and they will get fired from their job.

Patient appears SOB

Patient is short of breath

Patient refuses to take their medication

Patient has difficulty affording medication, or has had difficulty tolerating pills…..

Patient is paranoid and refuses to acknowledge

Consider revising using direct quotes.  “The transmitters in my brain tells me the medication is the devil.” 

Beware of just loading the macro

Patients will likely notice when they come for an ankle sprain and you preload the heart, lung and full neuro exam.

While this is not an exhaustive list, I think the take home message is that direct quotes and non-judgmental language will decrease concerns from patients and strengthen the quality of the medical record.  Knowing why the patient elected to be discharged, couldn’t take their medications, or providing direct quotes may even help other members of the care team give better care for the patient.  Medical records reflecting the compassionate and thoughtful care will build trust with the patient and result in more efficient care and better physician-patient relationships. 

There may be a few instances in which the physician may not want a note visible to the patient.  Examples include forensic nurse evaluations or instances in which a mother’s spouse may not be the father of an infant.  Check with your institution on how to opt out of sharing notes. While guided by the CURES Act each institution has its own workflow. 

Familiarizing ourselves with the CURES act in our daily practice our health system’s implementation will ensure the physician’s note reflects our commitment to safe and compassionate care.