ahahahaha..... I just callled EMS to go see a patient

[DarksideAllstar]

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Critical value reporting is bullsh*t. Discuss.

 

[yaah]

Nah. Critical value reporting exists for a reason. You have to tolerate a few silly ones and a lot of "I knew that already" calls, but there are a lot of surprises that do make a difference.

 

[pathstudent]

Having a system for reporting "critical values" are enforced by govt regulating agencies and lab crediting agencies because it is good patient care.

Usually the ordering doc knows about it or is expecting it or doesn't care about it, but there are enough instances where it makes a difference.

However, I see little educational value to getting residents involved in the loop. What a waste of time and what a way to increase inefficiency. I would hate it too if I had to get involved with reporting critical values.

 

[yaah]

That's true - the only time we really get involved here is on surg path when sometimes the attending asks us to notify someone of the dx. On CP, it is only if the lab can't get in touch with whoever they are supposed to (I had to deal with it once when a cardiology fellow wouldn't return pages about an INR of 10).

 

[DarksideAllstar]

That's true - the only time we really get involved here is on surg path when sometimes the attending asks us to notify someone of the dx. On CP, it is only if the lab can't get in touch with whoever they are supposed to (I had to deal with it once when a cardiology fellow wouldn't return pages about an INR of 10).

In this instance, the podiatry resident at one of the surgery clinics had ordered a set of labs on a patient, who, to the best of my knowledge probably has ESRD. Anyway, the K came back at 6.3 and it was not noted if the patient was going to HD that afternoon. The lab tried to call the physicians pager listed on the requisition. No dice. They tried to call the Podiatry Attendings pager. No dice. They tried to call the in house surgery resident and they were like "WTF? I don't know the podiatry patients, and oh yeah, I've got 40 patients on my service, half of whom are trying to keel over at the moment and you want me to track down a patient I don't know?" I call the patient at home. Again. And again. And one more time. Nothing. I finally called 911 and had them send a medic over to check the patient out. The lights were off and no one was home.

I guess my b*tch is that when people ORDER F*ING LAB TESTS either they should: 1. put down a pager number that works and that you will answer, or 2. direct us to someone whom will. Half the time the requisitions have just some "physician's name and pager number" who never even saw the patient and has no idea who they are. In this case, the podiatry resident clearly indicated that they should be called for criticals and specimen processing inquiries and they never returned one of the 20 pages that myself and the clin lab sent. I find it un-fing believable that physicians (in this case foot doctors) could be this irresponsible, but I guess at this point in my medical trainingI shouldn't be.

I agree with you pathstudent, I don't feel that this is the best use of my 1.5 hours last night. Hell, I was actually doing something productive (ie. learning) when I got paged. Otherwise, I agree that critical value reporting has its functions, but it only works if the ordering physician (or someone covering) is actually available to receive it.

 

[LADoc00]

first night of call as a resident in CP called EMS for a patient who was scheduled to have spinal surgery first thing in the morning and had a platelet count of 20. Unable to reach the resident on ortho spine. Patient disaster averted, LADOC hero once again.

 

[CameronFrye]

Last year when I was on Autopsy, I received a page at 3:30am. Although I was somewhat groggy and disoriented (I wasn't supposed to be on call), I called the number back. It was a micro tech calling to notify me of a critical value: the blood culture on one of my autopsy cases was growing Pseudomonas. I can laugh about it now, although I was somewhat miffed at the moment. However, I definitely agree that they are necessary. Once you start making exceptions, mistakes happen.

 

[pathstudent]

i wonder who pays the bill for ems in this case.

i sure as hell wouldn't pay it if I was the patient, especially it I was out and about doing my own thing.

Does the lab get the bill?

panic values on outpatient labs are a bit dubious. A lot of the times the material isn't run until the end of the day.

 

[emtcsmith]

I had a patient a few weeks ago who fell on lets say monday night, was transported to the ED and discharged that morning. The next night turns out there was "bleeding" noted on a scan and police were sent to the apartment when the patient didn't answer the phone. I arrived soon after to drive this totally stable patient 6 blocks back to the hospital. Note, he walked home after being discharged.

Please tell me when you have to call these patient's you attempt to arrange other means for the patient to get back to the hospital besides 911/EMS.

 

[SLUsagar]

i wonder who pays the bill for ems in this case.

i sure as hell wouldn't pay it if I was the patient, especially it I was out and about doing my own thing.

Does the lab get the bill?

panic values on outpatient labs are a bit dubious. A lot of the times the material isn't run until the end of the day.

this is a great point. i mean i'm all about doing what's right for the patient, but when on cp we were strongly urged to refrain from telling the pt to go to the ER or calling EMS etc. instead, if possibly indicated, have one of the clinicians handle that part. not a punt; rather, let someone who does clinical medicine handle it, who's better equiped...you wouldn't want an INTERNIST (or surgeon, etc etc) calling the OBGYN on YOUR missed AB H&E slides where he/she couldn't find any POC ...would you?