- Joined
- Dec 28, 2012
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- 408
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I feel like our hospitalists admit less and less at the smaller hospitals where consultants are not available, and that creates big problems when bigger facilities don't have beds available.
- CHF on 2L O2 -> Might get worse so needs transferred for Cardiology. Whe we call Cardiology, they are confused about why our Hospitalists won't admit for diuresis here.
- Grandma has the stomach bug going around and is dehydrated, so her creatinine increased from 1.5 to 2.3. She would benefit from observation, fluids, and rechecking until po intake improves -> Hospitalist says the patient needs transferred for Nephrology consultation.
- Grandpa has a lumbar compression fracture, is having a hard time ambulating despite your best pain control efforts in the ED, and needs better pain control before he can go home. He might also benefit from PT/OT, and SNF placement. Spine surgery has already been consulted by phone, recommends supportive care +/- a TLSO for comfort, and follow up in the clinic -> Hospitalist won't admit because we don't have spine surgery here "in case he gets worse."
Whenever we try to transfer these patient's the doctors at the receiving hospitalist act like we are crazy for trying to transfer patients that can clearly be managed at any hospital with a general medicine service.
At our tertiary hospital, the Hospitalists seem to consult Cardiology for every slight CHF patient needing diuresis for a day or 2, ID for run of the mill infections and ABX management, Nephrology for mild or moderate pre-renal AKI, etc.
At this point... I'm not really sure how our Hospitalists can even justify being there. I guess they exist simply because the specialists won't admit their own patients.
On a related note... Has anybody had luck convincing hospitalists to admit uncomplicated SBOs at smaller hospitalist without General Surgery? The vast majority of SBOs do not require surgery, so I feel like it's reasonable to admit for bowel rest, fluids, NG tube if needed, and then transfer later if no improvement or if the patient decompensates. Obviously this would not apply to patients with an obvious anatomic cause of the obstruction such as an incarcerated hernia or other surgical problem.
Thoughts?
- CHF on 2L O2 -> Might get worse so needs transferred for Cardiology. Whe we call Cardiology, they are confused about why our Hospitalists won't admit for diuresis here.
- Grandma has the stomach bug going around and is dehydrated, so her creatinine increased from 1.5 to 2.3. She would benefit from observation, fluids, and rechecking until po intake improves -> Hospitalist says the patient needs transferred for Nephrology consultation.
- Grandpa has a lumbar compression fracture, is having a hard time ambulating despite your best pain control efforts in the ED, and needs better pain control before he can go home. He might also benefit from PT/OT, and SNF placement. Spine surgery has already been consulted by phone, recommends supportive care +/- a TLSO for comfort, and follow up in the clinic -> Hospitalist won't admit because we don't have spine surgery here "in case he gets worse."
Whenever we try to transfer these patient's the doctors at the receiving hospitalist act like we are crazy for trying to transfer patients that can clearly be managed at any hospital with a general medicine service.
At our tertiary hospital, the Hospitalists seem to consult Cardiology for every slight CHF patient needing diuresis for a day or 2, ID for run of the mill infections and ABX management, Nephrology for mild or moderate pre-renal AKI, etc.
At this point... I'm not really sure how our Hospitalists can even justify being there. I guess they exist simply because the specialists won't admit their own patients.
On a related note... Has anybody had luck convincing hospitalists to admit uncomplicated SBOs at smaller hospitalist without General Surgery? The vast majority of SBOs do not require surgery, so I feel like it's reasonable to admit for bowel rest, fluids, NG tube if needed, and then transfer later if no improvement or if the patient decompensates. Obviously this would not apply to patients with an obvious anatomic cause of the obstruction such as an incarcerated hernia or other surgical problem.
Thoughts?