Special Considerations For Hotel/Motel Calls

Background:

When Call Doctor started in 1985 we were immediately contacted by the commercial hotels and began making calls. At one time, Dr. Bayne was the "house doctor" for La Valencia Hotel in La Jolla for a year and for the four Atlas Hotels in San Diego. Two types of services were requested: for guests and for injured employees.

A. Injured Employees:

All on the job injuries require a filing of the "First Report" to the state describing the injury and circumstances. This report does not lead to a bill or payment and is separate from the insurance issues or payment. The fact that an employer may wish to pay directly for our services does not relieve us from filing the First Report. Employers often wish to pay directly for lower cost services, as their workman's compensation insurance rates are predicated on the number of accidents submitted for insurance payment. The most common hotel injury is the hand laceration in the kitchen. Dispatch should be sure of the nature of the accident and dispatch only a van team with suturing capability and a physician comfortable with doing it.

Workman's injuries are highly litigious and we are performing only the initial treatment and management. All subsequent referral should be performed by the appropriate specialist, since the patients are ambulatory by definition. A list of referral physicians is kept at the dispatch center.

B. Hotel Clients:

Vacationers and conventioneers have spent a large amount of money coming to San Diego, often tied up in package trip deals with no recourse. We should be sensitive to the strong desire for these patients to recover as much of their vacation plans as possible. Families are often involved, so that the initial treatment not only has implications for the patient, but for the family as well. In our experience, hsopitalization is rarely necessary as hotels represent an essentially well group of individuals.

The hotel has a compelling reason to maintain the room rental and avoid medical risk. Hence, we never engage the hotel personnel in medical matters, share information, or solicit their help with one exception: a female standby is obligatory in some situations, such as the solo physician call in the younger female patient (under 65). Usually, there is a female janitor or clerk willing to standby for a minute, but we must be sensitive to the fact they have no medical background and should also be insulated from patient privacy issues as much as possible.

Other, specific issues to be considered as additive to the complexities of the normal housecall:

1. Dispatch: secure parking instructions if possible from the hotel; most will allow use of the valet lot for 30 minutes, the average length of a hotel call (they are medically much simpler). If possible, find which tower, building, etc the patient is in and where the front desk is to check in.
2. Tech: beware of vertical obstructions as many hotel entrances have awnings, etc
3. Tech: always go by the front desk, give the doctor's card and tell them we are visiting Room X
4. Xrays: avoid if at all possible. When necessary, use the staff elevator and service entrance; shoot only out the window, never through the wall unless you know there is no-one on the other side. There is no radiation risk, but the appearance of risk is too inflammatory. Having family members in the room during an exposure is not permissible.
5. Lab/urine: never carry sharps, infectious waste, or fluid in open containers or visible. Place in doc box or bag before the leaving the room. Take all trash but dry, clean paper with you.
6. Establish follow-up for any unforeseen emergency that is failsafe: reminder of 911, name of closest emergency room, and our phone number are sufficient. Generally, no follow up by us is done, as patients that sick probably ought to be referred to a office-based specialist or admitted within 24 hours.

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