In our ER we love the hospitalists.
Here is how getting a patient admitted used to go.
ER doc talking to patients primary care: "I have your patient Debra Peel here, she has fallen and needs to be admitted for ORIF of her right hip.
PCP: Well.....thanks for calling me but I don't really admit any more, why don't you get her admitted by Ortho.
ER doc talking to Ortho on call: I have a patient here who is 67 and fell today in her driveway. She has a femoral neck fracture that will need repaired.
Ortho Doc: Why don't you have her primary admit and we'll consult for the fracture.
ER Doc: She doesn't really have any medical problems, only takes one pill for her BP which seems to be well controlled. And besides, her doc is Dr. X, he doesn't admit.
Ortho Doc: Well we prefer to just consult, why don't you call the on call?
ER Doc talking to medicine on-call Doc: I have a patient who needs to be admitted for a hip fracture. I've talked to ortho and they requested we call you and they will consult. Her primary is Dr. X and he doesn't admit.
Medicine doc: Why can't ortho admit?
Anyway, you get the idea, multiple phone calls to multiple doctors to get someone to finally cave and admit - an ordeal that could sometimes take hours.
NOW IT GOES LIKE THIS.......
ER Doc to the Hospitalist: I have an admit for you.
Hospitalist: OK, I'll be right there.
LOVE THEM!
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- ERnursey
- A hardworking ER nurse trying to survive until retirement and if I can have little fun or have a positive impact on someone's life, all the better!
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9 comments:
Where I work, the hospitalists often say "I've already taken 15 admissions today, what am I supposed to do for a lady with a hip fracture anyway?"
And they're right. It's ultimately Ortho's responsibility to admit that sort of patient. There are plenty of complicated medical patients that I'd like them to admit promptly, so maybe they shouldn't be overextending themselves.
We prefer to consult?
I prefer to hit people.
We could both get what we want.
Well, it might go that way once.
Maybe I should have stayed in charm school long enough to graduate. :-)
Ditto.
Had a hospitalist admitting a patient last week, and in the middle of the process, she coded. He came down and ran the code even though she was still in the ER, because the ER docs were swamped and she was "almost his patient".
I lurrrve me some hospitalists.
Well, until they turn into Scalpel's hospitalists.
I kinda understand Scalpel's Hospitalist's PoV sometimes thought. Where I used to work at, man they got dumped on big time.
I really felt sorry for them sometimes, especially in the way certain ortho surgeons would treat them.
But, despite it all, they were mostly a cheerful lot.
There were a couple I really loved - because no matter how bad the day got, I never saw them lose their temper or get flustered.
Frustrated, yes.
But never in the blow-my-top type. They were awesome and we often went outta our way to help when they were rounding on the floor.
cheers,
My opinion:
In a primary surgical patient with no medical issues, the surgeon should admit. Other wise, what is my role?
Now, if the surgeon would like me to consult for medical clearance, I am certainly fine with that, but there is no reason for me to bill the insurance company for a daily progress not if nothing is going on from the medical front. That's just expensive medicine.
I think that other than the specialists, the hospitals should be staffed by hospitalists. Maybe then people would be discharged in a timely manner and the ER could get beds!
Debra Peel? Ha! Cracked me right up! :-) Thanks for the chuckle!!
In my ER, ortho stuff gets admitted by ortho, and hospitalsts are happy to consult. Oh, and if we have more than 2 admits, the back up hospitalist (or 2) pitches
in. Now, if only we could get the ICU to take the patients in a timely fashion.
I agree with Happy and Scalpel -- if a hospitalist isn't busy, they are usually fine with admitting a hip fracture just to keep things moving. However, hospitalist programs often suffer from a "can't say no" problem, leading them to take on more work than they can reasonably do.
The primary purpose of a hospitalist (at this time in history) is to admit medical patients and provide them with excellent, efficient, and quality care. The other stuff we can decide to do as time and resources permit.
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