Children Are Dying in Ill-Prepared Emergency Rooms Across America

[wamcp]

WSJ News Exclusive | Children Are Dying in Ill-Prepared Emergency Rooms Across America

Hospitals and regulators have done little to ensure E.R.s are ready to treat children in emergencies, while researchers prove taking basic steps can save lives.

www.wsj.com

This a sensationalist hit piece or truth?

Only about 14% of emergency departments nationwide have been certified as ready to treat kids, or are children’s hospitals specializing in treating young patients, The Wall Street Journal found.
Many emergency doctors don’t treat enough children to be able to spot life-threatening illnesses obscured by run-of-the-mill symptoms, or conditions more common in kids. Some E.R. staff default to drug doses and protocols meant for adults and either don’t have or don’t know where to find child-size gear in a crisis.

---

Members don't see this ad.

 

[JacobMcCandles]

Are child deaths up? Anecdotally, I can’t say that I’ve seen or heard about this in my area.

 

[cyanide12345678]

I will be honest, it’s been a while since I’ve seen an actual sick child on the brink of death, i will probably not know where things are and it will probably not be as good care as you can get at a children’s hospital. Our rural ER maybe sees less than 5 actual sick kids a year.

 

[Apollyon]

The RRC says 4% of pts seen in residency have to be peds. Even PEM docs say there aren't enough sick kids. I'm guessing 'sensational hit piece'.

 

[southerndoc]

Who certifies EDs as "ready to treat kids"?!? The article mentions that some states have no certification process. Are they included in the denominator when they cannot go through a certification process? Did I miss something that JC certifies EDs as child-ready?

 

[Dr Mantis Toboggan]

The RRC says 4% of pts seen in residency have to be peds. Even PEM docs say there aren't enough sick kids. I'm guessing 'sensational hit piece'.

And that’s for EM residency trained folks. Many very rural hospitals now are PA/NP only. There is a very high chance such an individual will never have resuscitated a child during their training, ever.

 

[EctopicFetus]

And that’s for EM residency trained folks. Many very rural hospitals now are PA/NP only. There is a very high chance such an individual will never have resuscitated a child during their training, ever.

Or IM trained which also do not take care of kids let alone sick kids in their training.

FP definitely doesn’t treat sick kids as part of their training either but at least they treat kids.

Stupid article.

 

[Tiger26]

I think it's fair to say that EDs are neither as good at nor as prepared to treat a critically ill kid as an adult. A large reason for that is that there are probably 10,000 to 1 critically ill adults for every similar kid.

We could probably do better with simulation and ensuring standardized equipment is always present to improve our readiness. That said, I still don't think kids are dying at a higher rate than adults.

A bigger problem is that it's harder to pick the needle out of the haystack when I'm seeing 5 kids a shift for the most ridiculous reasons. We get conditioned to kids not being sick.

 

[VA Hopeful Dr]

Or IM trained which also do not take care of kids let alone sick kids in their training.

FP definitely doesn’t treat sick kids as part of their training either but at least they treat kids.

Stupid article.

Sure we do

 

[EctopicFetus]

Sure we do

Did you do a picu rotation? Where did you treat sick kids? Inpatient peds service?

I’m not flaming FP but most kids on the floor are super stable and I doubt the residents are there managing them in the rare instance they decompensate.

Educate me. The only sick kids I can recall were in the picu and the Ed.

 

[Boatswain2PA]

Many very rural hospitals now are PA/NP only. There is a very high chance such an individual will never have resuscitated a child during their training, ever.

Very true for NPs, but not for PAs which I believe requires peds rotation.

My peds rotation was clinic, PICU and NICU. One of my ED rotations was partially in the PEM, and my trauma rotation saw too many kids.

In practice I see quite a few sick kids as well. I've intubated four kids, including a 2 year old, this year already (2 OD and 2 in status).

 

[VA Hopeful Dr]

Did you do a picu rotation? Where did you treat sick kids? Inpatient peds service?

I’m not flaming FP but most kids on the floor are super stable and I doubt the residents are there managing them in the rare instance they decompensate.

Educate me. The only sick kids I can recall were in the picu and the Ed.

Inpatient peds (where yes, kids do decompensate or the ED gets the diagnosis wrong - not a slight on them, none of us are perfect). Much like adult inpatient we get paged first and call the attending urgently if needed or when things settle out if not.

In my state, FP residency programs that have Peds EDs have the residents rotate there. My program didn't, so they instead set up what was almost a freestanding peds ED. We weren't set up for major trauma but anything else peds could come there and be managed or stabilized and transfered to a tertiary center if subspecialty care was needed. The pediatricians who staffed it were all EM-fellowship trained for what that's worth.

This doesn't make us the equal of EM-trained physicians by any means, but to claim we don't treat sick kids is ridiculous.

 

[BoardingDoc]

Very true for NPs, but not for PAs which I believe requires peds rotation.

My peds rotation was clinic, PICU and NICU. One of my ED rotations was partially in the PEM, and my trauma rotation saw too many kids.

In practice I see quite a few sick kids as well. I've intubated four kids, including a 2 year old, this year already (2 OD and 2 in status).

You've intubated 4 kids in the ED this year? What? You either work in an area with a disproportionately high number of extremely sick kids, or your threshold to intubate is considerably lower than mine.

 

[Boatswain2PA]

You've intubated 4 kids in the ED this year? What? You either work in an area with a disproportionately high number of extremely sick kids, or your threshold to intubate is considerably lower than mine.

Things come in waves. All 4 this year were in first six months.

I might see more sick kids proportionally here because of socioeconomic (probably higher birthrate and definitely lower education), but I wouldn't say definitively so.

Yes, we have a lower threshold to intubate here as almost all reasonably sick people get flown out.

That being said, you would have intubated all 4 of these kids.
- 2 yo respiratory failure after eating ALL of parents edibles: low RR, hypoxic acidosis.

- 13 yo old status despite max versed, Keppra, phosphenytoin, propofol. Finally stopped as I was going to put in cvl for phenobarb and pressors.

- 12 yo with polypharm OD, lengthy transport with vomiting and aspiration enroute, low GCS, combative and hypoxic. She was in ICU for weeks.

-6 yo with status, I think this was her 4th intubation already. This was done with a PEM looking over my shoulder.

 

[TooMuchResearch]

After reading this piece, I'll have to move my family somewhere with more sick kids...

 

[GonnaBeADoc2222]

Widespread vaccination has (thankfully) reduced the number of acutely dying children by magnitudes.

Parents of chronically ill children have the mandate to live as close as possible to their academic quaternary childrens hospital. Sorry, no living in the boonies to "save money."

By definition, we won't be as good at the things we do less often as the things we do most often.

Therefore, recognizing this, society and hospitals can either pay us to receive more training by way of simulation or otherwise (which they won't), or pay for a trained PICU / NICU doc to be on call and on site for every hospital in America (which they certainly won't).

The result will be societal blaming of ER docs for the tragic, but very rare, preventable pediatric death.

 

[EctopicFetus]

Inpatient peds (where yes, kids do decompensate or the ED gets the diagnosis wrong - not a slight on them, none of us are perfect). Much like adult inpatient we get paged first and call the attending urgently if needed or when things settle out if not.

In my state, FP residency programs that have Peds EDs have the residents rotate there. My program didn't, so they instead set up what was almost a freestanding peds ED. We weren't set up for major trauma but anything else peds could come there and be managed or stabilized and transfered to a tertiary center if subspecialty care was needed. The pediatricians who staffed it were all EM-fellowship trained for what that's worth.

This doesn't make us the equal of EM-trained physicians by any means, but to claim we don't treat sick kids is ridiculous.

Let’s talk real numbers. How many kids outside of anesthesia under the age of 8 have you intubated?

The admissions number for peds are super low. This is a success of vaccinations and public health.

I don’t think a month of inpatient peds qualifies as meaningful experience. I would say an FP doc is way more prepared to deliver a baby than I am. I did my ob rotation in med school and residency and we had a ton of precipitous deliveries and deliveries with little to no prenatal care.

Doing a month or 2 of inpatient peds and a bit of a peds ed isn’t gonna cut it in my opinion.

Fwiw when I’m talking kids I’ll say kids under 8. A 6’2 240 lb 16 year old isn’t really a peds case in my opinion. Their treatment and illness resembles more what we would do for a 22 year old than a 2 year old.

 

[sdles]

Inpatient peds (where yes, kids do decompensate or the ED gets the diagnosis wrong - not a slight on them, none of us are perfect). Much like adult inpatient we get paged first and call the attending urgently if needed or when things settle out if not.

In my state, FP residency programs that have Peds EDs have the residents rotate there. My program didn't, so they instead set up what was almost a freestanding peds ED. We weren't set up for major trauma but anything else peds could come there and be managed or stabilized and transfered to a tertiary center if subspecialty care was needed. The pediatricians who staffed it were all EM-fellowship trained for what that's worth.

This doesn't make us the equal of EM-trained physicians by any means, but to claim we don't treat sick kids is ridiculous.

Not to derail, but I've always had an issue with this perspective. The admitting team is just as complicit in missed diagnosis as the ED, and generally have more time to investigate the patients history, more vitals to trend, etc. They have performed a full history and physical independent of the ER.

 

[Janders]

Not to derail, but I've always had an issue with this perspective. The admitting team is just as complicit in missed diagnosis as the ED, and generally have more time to investigate the patients history, more vitals to trend, etc. They have performed a full history and physical independent of the ER.

Yep. Love the HD#3 decompensation blamed on the ED MD miss… what about the admitting doc, the rounding doc x 2, the two consultants who saw the case…

 

[xaelia]

I can just about smell an unfunded mandate for a pediatrics-ready certification standard! TJC is probably already drawing up the inspection draft and preparing their lobbying efforts ...

 

[psychemdoc]

Widespread vaccination has (thankfully) reduced the number of acutely dying children by magnitudes.

Parents of chronically ill children have the mandate to live as close as possible to their academic quaternary childrens hospital. Sorry, no living in the boonies to "save money."

By definition, we won't be as good at the things we do less often as the things we do most often.

Therefore, recognizing this, society and hospitals can either pay us to receive more training by way of simulation or otherwise (which they won't), or pay for a trained PICU / NICU doc to be on call and on site for every hospital in America (which they certainly won't).

The result will be societal blaming of ER docs for the tragic, but very rare, preventable pediatric death.

Well said. Very balanced and ultimately realistic.

 

[VA Hopeful Dr]

Not to derail, but I've always had an issue with this perspective. The admitting team is just as complicit in missed diagnosis as the ED, and generally have more time to investigate the patients history, more vitals to trend, etc. They have performed a full history and physical independent of the ER.

Yes and that's where 99.9% of what I would call ED misses come from. It's not something I generally blame on the ER. I had the advantage of their work up plus my own H&P.

This is not meant as a slight against the ER in any way as I noted previously.

Do keep in mind that I'm the PCP who defends y'all against patient complaints I get about whatever pisses them off.

 

[VA Hopeful Dr]

Let’s talk real numbers. How many kids outside of anesthesia under the age of 8 have you intubated?

The admissions number for peds are super low. This is a success of vaccinations and public health.

I don’t think a month of inpatient peds qualifies as meaningful experience. I would say an FP doc is way more prepared to deliver a baby than I am. I did my ob rotation in med school and residency and we had a ton of precipitous deliveries and deliveries with little to no prenatal care.

Doing a month or 2 of inpatient peds and a bit of a peds ed isn’t gonna cut it in my opinion.

Fwiw when I’m talking kids I’ll say kids under 8. A 6’2 240 lb 16 year old isn’t really a peds case in my opinion. Their treatment and illness resembles more what we would do for a 22 year old than a 2 year old.

What about 4 months of inpatient peds and a month of peds ED?

And again, I'm not saying this puts me anywhere near your ability to treat sick kids. This is purely a response to you saying we don't get any experience with sick kids and that's just not accurate.

 

[TooMuchResearch]

Not to derail, but I've always had an issue with this perspective. The admitting team is just as complicit in missed diagnosis as the ED, and generally have more time to investigate the patients history, more vitals to trend, etc. They have performed a full history and physical independent of the ER.

The number of times a hospitalist has copy pasted my hpi (on an awake patient that can give history)...
They also appreciate it if I order and get results on every test and call every consult the patient might need during the admission, which I don't, but they're pretty good at bullying some people into doing it.

 

[TooMuchResearch]

Yep. Love the HD#3 decompensation blamed on the ED MD miss… what about the admitting doc, the rounding doc x 2, the two consultants who saw the case…

I saw an ED peer review for a missed femur fracture in a paraplegic patient.
The fracture was found several days into admission and had been missed by everyone, including orthopedics. I don't honestly remember what they were consulted for since there wasn't a known fracture at the time.

 

[EctopicFetus]

What about 4 months of inpatient peds and a month of peds ED?

And again, I'm not saying this puts me anywhere near your ability to treat sick kids. This is purely a response to you saying we don't get any experience with sick kids and that's just not accurate.

I get it.. my issue remains.. i quickly looked and it appears there are about 4500 filled FP spots per year. We also have Peds residents. How many / how often did this happen in the 6 months you spent in the ED / floors and how many times were you in charge vs the peds resident.

This isnt to disparage FP. Simply there aren’t a bunch of sick kids, i loved my peds rotation as a med student. I almost did peds to do PICU/NICU. Even in my time in a super busy academic PICU many of those kids were stable and not in need of acute action. Some were there as part of their chemo protocol, post surgical stuff etc. Rarely did a kid truly decompensate in the PICU.

Perhaps i should clarify and say not remotely enough experience with sick kids. In my opinion this will only happen in a Peds ED attached to a hospital with tertiary and quarternary care and the PICU In my opinion. Most EM residencies dont get enough of this either In my opinion.

 

[VA Hopeful Dr]

I get it.. my issue remains.. i quickly looked and it appears there are about 4500 filled FP spots per year. We also have Peds residents. How many / how often did this happen in the 6 months you spent in the ED / floors and how many times were you in charge vs the peds resident.

This isnt to disparage FP. Simply there aren’t a bunch of sick kids, i loved my peds rotation as a med student. I almost did peds to do PICU/NICU. Even in my time in a super busy academic PICU many of those kids were stable and not in need of acute action. Some were there as part of their chemo protocol, post surgical stuff etc. Rarely did a kid truly decompensate in the PICU.

Perhaps i should clarify and say not remotely enough experience with sick kids. In my opinion this will only happen in a Peds ED attached to a hospital with tertiary and quarternary care and the PICU In my opinion. Most EM residencies dont get enough of this either In my opinion.

My program was unopposed so there were no peds residents.

If that is your opinion on sufficient experience to care for sick kids, then I would say quite a few opposed FM residencies can manage it.

Here in SC we have 3 major children's hospitals - MUSC, Columbia, and Greenville. All 3 FM programs at those locations require peds ED time (ranging from Columbia at 2 weeks to Greenville at 2 months). All can easily do elective PICU time since all 3 places have pretty good PICUs.

Interestingly, Columbia and MUSC have 1 month of PICU time (so one elective for FM) while Greenville doesn't require it at all - but Greenville is the newest program so I can't say I'm surprised by this. Heck, Greenville tried to hire me as an ED doctor fresh out of residency.

 

[Janders]

I saw an ED peer review for a missed femur fracture in a paraplegic patient.
The fracture was found several days into admission and had been missed by everyone, including orthopedics. I don't honestly remember what they were consulted for since there wasn't a known fracture at the time.

I have a stack of examples but my absolute fav was—
Young person presents peri-arrest, grey, ashen, comatose with some respiratory effort. Dropped off front door by family in private car. Stated as “had a bad asthma attack”. As we are carrying them into a resus room there is a comment “it could be an allergic rxn”.

Anyway… about as close to death as you get; I/O, IV, fluid, IM epi, IV epi, IV Mag, IV solumedrol all being done, Airway being obtained, patient placed on cardiac monitor IN A WIDE COMPLEX DEATH RHYTHM cardioverted, now no respiratory efforts—> intubated. INCREDIBLY hard to ventilate d/t bronchs spasm; hand-bagged with endtidals >100 for probably 20min, leaning our body weight onto their chest to force exhales. Eventually we get them good enough to get onto a vent, xfer to tertiary center. Gets extubated. Neuro intact. Sees EP who notes WPW and recommends ablation. Turns out the whole thing was an anaphylactic reaction to NSAID in a patient w/ severe asthma and prior anaphylaxis to NSAIDS…

… Then we get the formal peer review. Turned out the patient had a non-displaced hand fracture from punching a wall, which is why they took an NSAID, which is why they basically died. The complaint is we missed the hand fracture and didn’t splint it prior to xfer. As it turns out, the tertiary center also missed it in their ED, ICU, and floor and amongst the multiple consultants and PT/OT that saw said patient. Patient went to an UC after discharge b/c their hand still hurt…

 

[ScepticSkeksis]

I have a stack of examples but my absolute fav was—
Young person presents peri-arrest, grey, ashen, comatose with some respiratory effort. Dropped off front door by family in private car. Stated as “had a bad asthma attack”. As we are carrying them into a resus room there is a comment “it could be an allergic rxn”.

Anyway… about as close to death as you get; I/O, IV, fluid, IM epi, IV epi, IV Mag, IV solumedrol all being done, Airway being obtained, patient placed on cardiac monitor IN A WIDE COMPLEX DEATH RHYTHM cardioverted, now no respiratory efforts—> intubated. INCREDIBLY hard to ventilate d/t bronchs spasm; hand-bagged with endtidals >100 for probably 20min, leaning our body weight onto their chest to force exhales. Eventually we get them good enough to get onto a vent, xfer to tertiary center. Gets extubated. Neuro intact. Sees EP who notes WPW and recommends ablation. Turns out the whole thing was an anaphylactic reaction to NSAID in a patient w/ severe asthma and prior anaphylaxis to NSAIDS…

… Then we get the formal peer review. Turned out the patient had a non-displaced hand fracture from punching a wall, which is why they took an NSAID, which is why they basically died. The complaint is we missed the hand fracture and didn’t splint it prior to xfer. As it turns out, the tertiary center also missed it in their ED, ICU, and floor and amongst the multiple consultants and PT/OT that saw said patient. Patient went to an UC after discharge b/c their hand still hurt…

I see this nonsense in trauma all the times. We diagnose the SDH or PTX, admit the intubated patient to the trauma team, then I get a nastygram a few days later about some minor fracture that "The ED physician missed".

 

[AlmostAnMD]

I can just about smell an unfunded mandate for a pediatrics-ready certification standard! TJC is probably already drawing up the inspection draft and preparing their lobbying efforts ...

I'm all for it

as long as my tertiary hospital that does deliveries only with no peds services doesn't do the certification and says we can't see patients under 18 anymore

 

[southerndoc]

I have a stack of examples but my absolute fav was—
Young person presents peri-arrest, grey, ashen, comatose with some respiratory effort. Dropped off front door by family in private car. Stated as “had a bad asthma attack”. As we are carrying them into a resus room there is a comment “it could be an allergic rxn”.

Anyway… about as close to death as you get; I/O, IV, fluid, IM epi, IV epi, IV Mag, IV solumedrol all being done, Airway being obtained, patient placed on cardiac monitor IN A WIDE COMPLEX DEATH RHYTHM cardioverted, now no respiratory efforts—> intubated. INCREDIBLY hard to ventilate d/t bronchs spasm; hand-bagged with endtidals >100 for probably 20min, leaning our body weight onto their chest to force exhales. Eventually we get them good enough to get onto a vent, xfer to tertiary center. Gets extubated. Neuro intact. Sees EP who notes WPW and recommends ablation. Turns out the whole thing was an anaphylactic reaction to NSAID in a patient w/ severe asthma and prior anaphylaxis to NSAIDS…

… Then we get the formal peer review. Turned out the patient had a non-displaced hand fracture from punching a wall, which is why they took an NSAID, which is why they basically died. The complaint is we missed the hand fracture and didn’t splint it prior to xfer. As it turns out, the tertiary center also missed it in their ED, ICU, and floor and amongst the multiple consultants and PT/OT that saw said patient. Patient went to an UC after discharge b/c their hand still hurt…

If that was referred to me for initial review, I would give you a kudos letter for saving the kids life. Seriously. Some of this crap should never make it to a peer review committee. The initial reviewer should realize that you saved the kid's life and the hand fracture couldn't be assessed during his critical presentation. WTH

 

[TooMuchResearch]

I have a stack of examples but my absolute fav was—
Young person presents peri-arrest, grey, ashen, comatose with some respiratory effort. Dropped off front door by family in private car. Stated as “had a bad asthma attack”. As we are carrying them into a resus room there is a comment “it could be an allergic rxn”.

Anyway… about as close to death as you get; I/O, IV, fluid, IM epi, IV epi, IV Mag, IV solumedrol all being done, Airway being obtained, patient placed on cardiac monitor IN A WIDE COMPLEX DEATH RHYTHM cardioverted, now no respiratory efforts—> intubated. INCREDIBLY hard to ventilate d/t bronchs spasm; hand-bagged with endtidals >100 for probably 20min, leaning our body weight onto their chest to force exhales. Eventually we get them good enough to get onto a vent, xfer to tertiary center. Gets extubated. Neuro intact. Sees EP who notes WPW and recommends ablation. Turns out the whole thing was an anaphylactic reaction to NSAID in a patient w/ severe asthma and prior anaphylaxis to NSAIDS…

… Then we get the formal peer review. Turned out the patient had a non-displaced hand fracture from punching a wall, which is why they took an NSAID, which is why they basically died. The complaint is we missed the hand fracture and didn’t splint it prior to xfer. As it turns out, the tertiary center also missed it in their ED, ICU, and floor and amongst the multiple consultants and PT/OT that saw said patient. Patient went to an UC after discharge b/c their hand still hurt…

"Holy **** he survived neuro intact. That's amazing. I didn't read the part about the ridiculous complaint."

 

[JacobMcCandles]

Patient went to an UC after discharge b/c their hand still hurt…

I really thought the punchline was going to be the ED diagnosed it because the urgent care referred them to the ED.

 

[Tenk]

I mean it’s true, but it’s true for kids and adults. If you show up sick as **** at any age, you have a higher chance of survival at a level 1 big trauma place over a podunk hole in the wall.

Grass is green, the sky is blue, taking meth when you are withdrawing from alcohol will give you mega withdrawal.

 

[TooMuchResearch]

Killed three kids today just on my own. Still early in the shift too.

 

[GassYous]

Killed three kids today just on my own. Still early in the shift too.

I don't blame you, my kid has also narrowly dodged death several times

 

[Arcan57]

… Then we get the formal peer review. Turned out the patient had a non-displaced hand fracture from punching a wall, which is why they took an NSAID, which is why they basically died. The complaint is we missed the hand fracture and didn’t splint it prior to xfer. As it turns out, the tertiary center also missed it in their ED, ICU, and floor and amongst the multiple consultants and PT/OT that saw said patient. Patient went to an UC after discharge b/c their hand still hurt…

I hope such a dangerous physician is no longer practicing. At the very least, reported to the board and spammed into oblivion with 1-star Google reviews.





.... but also I'm hoping the doc that took care of that patient never hears or sees anything about that case other than survived neuro intact. Some stuff you just decide not to pass on as the director.

 

[PTPoeny]

This article has been a big topic of discussion in my group. As far as I can figure out the "certification" of readiness is voluntary and the actual peer reviewed publication uses this:
National Pediatric Readiness Project

The checklist is available for anyone to download and read.

 

[Splenda88]

The number of times a hospitalist has copy pasted my hpi (on an awake patient that can give history)...
They also appreciate it if I order and get results on every test and call every consult the patient might need during the admission, which I don't, but they're pretty good at bullying some people into doing it.

Nice for taking a dig at hospitalists.

 

[VA Hopeful Dr]

Nice for taking a dig at hospitalists.

Eh, every branch of medicine has some bad actors. EPs interact with more other specialties than most so see more of those subpar doctors.

Plus it's their forum, they can complain about who they want.

 

[BoardingDoc]

Eh, every branch of medicine has some bad actors. EPs interact with more other specialties than most so see more of those subpar doctors.

Plus it's their forum, they can complain about who they want.

Man, don't get me started about those F****** family med docs. /s

 

[TooMuchResearch]

Nice for taking a dig at hospitalists.

Did you read what I was replying to? Is it a dig to say that they literally copy/paste my HPI and don't add anything else and then the ED gets reviewed when a new diagnosis is found three days into a hospital admission?

 

[Splenda88]

Did you read what I was replying to? Is it a dig to say that they literally copy/paste my HPI and don't add anything else and then the ED gets reviewed when a new diagnosis is found three days into a hospital admission?

Yeah, I read it.

 

[CoolDoc1729]

Nice for taking a dig at hospitalists.

I mean he’s just taking a dig at hospitalists who copy-paste an H&P - that’s pretty lame unless the patient has no family and is altered or intubated…

See it all the time and it does not enhance my respect for any of those who do it.

 

[Splenda88]

I mean he’s just taking a dig at hospitalists who copy-paste an H&P - that’s pretty lame unless the patient has no family and is altered or intubated…

See it all the time and it does not enhance my respect for any of those who do it.

There is a lot blame to go around.

I can also complain about the ED doc who called to admit a 32 y/o with intractable headache with unremarkable work up. And gave patient 2 narcotics, migraine cocktail to the point that I could not get a hx because patient was almost obtunded

I wonder if you call family member on every single patient that can't give you a hx.

 

[CoolDoc1729]

There is a lot blame to go around.

I can also complain about the ED doc who called to admit a 32 y/o with intractable headache with unremarkable work up. And gave patient 2 narcotics, migraine cocktail to the point that I could not get a hx because patient was almost obtunded

I wonder if you call family member on every single patient that can't give you a hx.

1- I agree. Physicians are great at blaming each other.
2. I am sorry about those of my colleagues that do **** like that. I don’t frequent the IM forum but I would imagine that could be a common topic there.
3. No I make the nurse do it lol but I don’t copy and paste anyone else’s notes ever, truly.

 

[Splenda88]

1- I agree. Physicians are great at blaming each other.
2. I am sorry about those of my colleagues that do **** like that. I don’t frequent the IM forum but I would imagine that could be a common topic there.
3. No I make the nurse do it lol but I don’t copy and paste anyone else’s notes ever, truly.

Amazingly, people in the IM forum do not talk about stuff like that.

Nice that you have someone else who can do it for you.

 

[Janders]

I love copy and pasting notes.
I do it in quote marks.

Some of our hospitalists like to do the same with my ED HPI, and attribute it to me. Then add what they get from patient / family. Seems cool.

Sometimes I see my hpi cut and paste word for word into an admission hpi and nothing added and no attribution.
I assume these people thinking I’m a kickass doctor and they have literally nothing to add to the case. I accept their compliment! It does seem a bit lazy on their end.

 

[Kryptocoin]

There is a lot blame to go around.

I can also complain about the ED doc who called to admit a 32 y/o with intractable headache with unremarkable work up. And gave patient 2 narcotics, migraine cocktail to the point that I could not get a hx because patient was almost obtunded

I wonder if you call family member on every single patient that can't give you a hx.

Anyone who gives narcotics for migraine or non-traumatic back pain at my current job gets peer-reviewed. We had a few doctors (most were non-EM trained) in the past that were pretty liberal with opiates for headache and back pain and it turned the ER into a pain clinic.

 

[Brigade4Radiant]

Anyone who gives narcotics for migraine or non-traumatic back pain at my current job gets peer-reviewed. We had a few doctors (most were non-EM trained) in the past that were pretty liberal with opiates for headache and back pain and it turned the ER into a pain clinic.

I hate chronic pain patients coming into the ED. They say they are allergic to nsaids and want iv meds.

did they send them home with opiates?