Label patients ‘unknown’ until identity confirmed

Risk managers agree the incident at Vanderbilt University Medical Center was baffling and unlikely to be repeated, but it may be reason to check the policy on identifying patients at your facility. You should have a system for handling patients whose identities are uncertain.

The tragedy at Vanderbilt seems to involve a series of odd mix-ups, but it’s not all that uncommon for patients to arrive in the emergency department without positive identification, says Denny L. Thomas, director of risk management at St. Joseph’s Hospital in Marshfield, WI.

At his own facility, emergency department patients sometimes show up with no identification on their bodies and without any family members to identify them. When the patient is unresponsive, certainly a common occurrence in an emergency, the staff must proceed with care without having positive identification.

The solution at St. Joseph’s is to label the patient "unknown" and assign a tracking number. The patient receives a plastic wristband like every other patient at the facility, but the wristband simply says "unknown" and lists the assigned number. All medical records, including tests and lab work, are identified with the unknown patient’s number.

If you have tentative identification of some sort, it is acceptable to add "possibly Jennifer Jones" to the "unknown" patient label. Wait until you get confirmation before changing it.

The hospital uses its disaster triage policy for labeling unknown patients, though there usually is just one unknown patient at a time. Unknown patients usually are identified within hours, but some have gone unidentified for two days.

Thomas offers this additional advice on dealing with unidentified patients:

Be skeptical about identification cards.

The materials found on the patient often can be counted on as positive identification, but not always. It is not unusual for a young patient to arrive with two driver’s licenses — one showing him to be of legal drinking age and one showing him to be younger. The younger one probably is correct, but don’t take any chances. Label the patient unknown until you get confirmation.

Don’t take the police officer’s word on identification.

This may seem counterintuitive, since the police are government officials and should know who they brought into the hospital. But it also appears the Vanderbilt mix-up began when a police officer passed on bad information to the hospital staff.

In addition to working as a hospital risk manager, Thomas works as a deputy coroner in his community. That means he has a lot of experience with identifying bodies, and he says he’s learned that well-meaning police officers can get the facts wrong. "I’ve seen many instances when the police give you information, and it turns out to be contrary to the truth because they were going on a driver’s license found in the car, or who the car is registered to, or something like that," he says. "My recommendation is that you shouldn’t go with the police identification. Use it as a possible identification, but get confirmation."

Family is best source

Consider the family the last word on identification.

Rely on the family to provide positive identification whenever there is doubt. But even when the family provides identification, consider how certain they are. Is the patient disfigured? Is the family confused by the clothing worn by the patient? "If the family seems reasonably certain, that can be your comfort level," Thomas says. "You can go with that as the identification. Mistakes are still possible, as the Vanderbilt situation shows, but you’re playing it safe by relying on the family."

Keep the patient’s clothing and other belongings secure.

The clothing and other belongings can be extremely important to securing an accurate identification from the family, especially if the patient is disfigured. Make sure the belongings are properly labeled with the unknown patient’s identification number.

Don’t let test results get lost once the patient is identified.

Be certain that your system includes a way for the patient’s proper identification to be changed once you identify him or her. There must be a way to tie the previous "unknown" status to the patient’s new identification. Otherwise, lab and test results ordered under the "unknown" status may never make it back to the now identified patient.