Code response responsibilities

[pd4emergence]

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For those in private practice, How does your hospital/group handle code responsibilities? I ask because my group is thinking about no longer responding to codes unless specifically called for an airway issue. We have no contractual obligation to go and lately have been getting stuck running codes/pronouncing patients/talking to families while we have cases going in the OR. Our ER docs are actually contractually obligated to go but half the time do not show up especially if they know we are there. The hospital employs our CRNA's and they go to all codes. So, most of the time the airway part is covered. I used to think we should go to all codes but now I am not so sure. Anyway, I am interested to hear how other practices deal with this issue. Thanks.

 

[Gas]

I don't think we should be running codes, pronouncing patients, or talking to their families. These families have never even met us before - it's more appropriate for the physician who is directly responsible for their care to notify the family of such issues. The obvious exception is codes under our watch, such as in the OR or the ICU if we have a presence there.

In our hospital, we respond if called for an airway issue, which happens every now and then. But we do not run the code. Sometimes, I will also help with central access. Based on our contract, we respond if we can. If we have another issue going on at the time, we don't go. Instead, they call an ER doc. I don't know the exact wording in the contract, and the whole issue is somewhat nebulous, but I would not want to pronounce a patient or talk to a family I've never met before.

 

[Fooper]

We don't take in-house call at our place, so when we're there we're in the OR & can't respond anyway. The ER docs have it in their contracts to handle the codes, which is good since they're used to them.

 

[militarymd]

I don't think we should be running codes, pronouncing patients, or talking to their families. These families have never even met us before - it's more appropriate for the physician who is directly responsible for their care to notify the family of such issues. The obvious exception is codes under our watch, such as in the OR or the ICU if we have a presence there.

In our hospital, we respond if called for an airway issue, which happens every now and then. But we do not run the code. Sometimes, I will also help with central access. Based on our contract, we respond if we can. If we have another issue going on at the time, we don't go. Instead, they call an ER doc. I don't know the exact wording in the contract, and the whole issue is somewhat nebulous, but I would not want to pronounce a patient or talk to a family I've never met before.

You mean all the stuff that regular DOCTORS do....

 

[pd4emergence]

My biggest thing in regards to responding to codes is that most of the time when a code is called cases are going in the OR. I don't think it is the best patient care for us to be responsible for a code situation when I am supervising cases downstairs. The other issue is that fact that because we are there and available these patient's primary (admitting) physicians get to stay in their comfy beds while we code their patients, write their death notes and talk to thier patients families. This happens only if the patient doesn't make it. If they do we routinely get asked to help transfer these patients to the ICU where by default we have to take over management because we are the only physicians around. Our ER group is by contract supposed to respond. I am coming around to the idea that we should just let them handle it and not get involved unless called for an airway issue.

 

[Gas]

You mean all the stuff that regular DOCTORS do....

If it's my patient, I'll do all those things. If it's some random patient I get called to on the floor/ICU, why should I go? I've got my own rooms to supervise in the OR. Those are my patients, and that is my primary responsibility. It's not about being a doctor. It's about doing what is best for YOUR patients.

 

[bullard]

What about renegotiating your contract so you actually get paid for doing all that stuff?

 

[zippy2u]

Another prime example of being "tooled" by the Administration. Dude, the only code blues you need to respond to are in the OR ,PACU or holding area. Tell the bean counters to hire a hospitalist with their own money to respond to the codes and your headache goes away. Regards, ----Zippy

 

[Magnus67]

You mean all the stuff that regular DOCTORS do....

Agree with above


Ya, just a dumb intern here, but don't complain about not being regarded as doctors and then say we shouldnt have to deal with these unpleasant things. Ive coded, pronounced, and talked to familes i have never seen before about 10 times this year. It sucks, its uncomfortable, but i feel its part of my job and will always be part of my job. 10 months of being a doctor has shown me doing the terrible parts of the job, and doing them well, make you much more of a "doctor" in the eyes of patients and staff than anything. But like I said, grain of salt, my 2 cents.

 

[militarymd]

Agree with above


Ya, just a dumb intern here, but don't complain about not being regarded as doctors and then say we shouldnt have to deal with these unpleasant things. Ive coded, pronounced, and talked to familes i have never seen before about 10 times this year. It sucks, its uncomfortable, but i feel its part of my job and will always be part of my job. 10 months of being a doctor has shown me doing the terrible parts of the job, and doing them well, make you much more of a "doctor" in the eyes of patients and staff than anything. But like I said, grain of salt, my 2 cents.

I've never had any problems with not being considered a Doctor....I've been at this long enough that I'm comfortable in my skin....

while at the same time, I feel that it is our responsibility to respond to codes when we can......

We are best trained for these situations...I would say better trained than the ER docs are...they'll argue that point though.

Just MY 2 cents....but obviously most of the other attendings here would rather not do something for which they are best trained to do.......

I would have to assume that they are just as comfortable as me in not being considered a doctor....but just "anesthesia"

 

[coprolalia]

We are best trained for these situations...I would say better trained than the ER docs are...they'll argue that point though.

You are correct, sir. They could argue, but they would be wrong.

Still, I understand the points about having other responsibilities. As a resident, we routinely go to codes to make sure the tube gets put in correctly. More often than not, we run the code because no one else (seems to) know what the hell to do... effectively, that is. (There's usually a lot of noise and bustle, but after an amp of epinephrine or two and atropine, the ideas quickly run out.)

Best scenario code I saw was an ortho patient who's stent had clogged up and he went into v-fib arrest. We worked the code for about 20 minutes in the room, the cardiology fellow showed up, took him to the cath lab, and he walked out of the hospital a week later.

Maybe we need to make the inpatient cardiologist on staff be in charge of all floor codes.

-copro

 

[deleted126335]

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[pd4emergence]

I've never had any problems with not being considered a Doctor....I've been at this long enough that I'm comfortable in my skin....

while at the same time, I feel that it is our responsibility to respond to codes when we can......

We are best trained for these situations...I would say better trained than the ER docs are...they'll argue that point though.

Just MY 2 cents....but obviously most of the other attendings here would rather not do something for which they are best trained to do.......

I would have to assume that they are just as comfortable as me in not being considered a doctor....but just "anesthesia"

Mil, what does we respond when we can mean? I think if everybody responded when they could then half the time nobody would show up. Somebody should have the primary responsibility to respond. I just don't think it should be the only anesthesiologist in house who is also covering OB and cases in the OR. What happens when you get caught running a code and a stat c section is called. I would say the last 2 or 3 times I have been to a code, I needed to be somewhere else but was the only MD there. I also don't agree with the best trained argument. Sure we are the best trained, but do you intubate everyone in your hospital that needs to be intubated just because you are the best trained. I can see both sides of this but I still think that our primary responsibilty should be to our patients in the OR and to our obligations to a relatively busy OB floor.

 

[militarymd]

Mil, what does we respond when we can mean? I think if everybody responded when they could then half the time nobody would show up. Somebody should have the primary responsibility to respond. I just don't think it should be the only anesthesiologist in house who is also covering OB and cases in the OR. What happens when you get caught running a code and a stat c section is called. I would say the last 2 or 3 times I have been to a code, I needed to be somewhere else but was the only MD there. I also don't agree with the best trained argument. Sure we are the best trained, but do you intubate everyone in your hospital that needs to be intubated just because you are the best trained. I can see both sides of this but I still think that our primary responsibilty should be to our patients in the OR and to our obligations to a relatively busy OB floor.

Practices are different....so I can only comment on mine.....

As a "doctor" who eats in the same doctor's lounge as a number of FP's, EM's, IM's , Cards, etc....who frequently aren't in house when shi t hits the fan....I do my best to take care of my colleagues' patients (meaning other members of my medical staff) as I can.

FWIW, no one call's me "anesthesia"...my collegaues appreciates the fact that a doctor who is present in the hospital does his best to take care of their patients when they aren't availabe.

This has NOTHING to do with contractual obligations with the hospital.

 

[awdc]

while at the same time, I feel that it is our responsibility to respond to codes when we can......

We are best trained for these situations...I would say better trained than the ER docs are...they'll argue that point though.

You're right we'll argue it. Running codes is our bread-and-butter plus we do any procedure that needs to be done short of the OR or cath lab. But you can believe what you want. By the end of the year, most EM interns have probably participated in and run more codes than any other resident in the hospital.

 

[VentdependenT]

You're right we'll argue it. Running codes is our bread-and-butter plus we do any procedure that needs to be done short of the OR or cath lab. But you can believe what you want. By the end of the year, most EM interns have probably participated in and run more codes than any other resident in the hospital.

Depends on the program.

 

[jetproppilot]

You're right we'll argue it. Running codes is our bread-and-butter plus we do any procedure that needs to be done short of the OR or cath lab. But you can believe what you want. By the end of the year, most EM interns have probably participated in and run more codes than any other resident in the hospital.

I wrote a buncha crap in response to this greenie's post...

then deleted it after a light bulb went off in my head.

Cuz come to think of it, I too thought I knew everything when I was a resident.

Boy, was I way off.

So I'll tone it down a little.

Slim, when your head comes back down to planet earth, ohhhh we're talkkin about probably ten years from now,

talk with any anesthesiologist who does alotta hearts.

Better yet, talk with Venty in a year....after his CV anesthesia fellowship.

I beg to differ with you, Slim.

btw, can you intubate a gravid fire ant?

 

[rsgillmd]

In my hospital, the anesthesia resident carrying the code pager (usually the PACU resident during the day or the senior/cardiac resident at night) responds. We intubate and leave, although I have found myself on occasion (usually July and August) politely directing the medical residents.

When I was at Jersey City, the medical residents ran the codes there as well, but the Resp. Therapist intubated. However, there the senior resident in the ICU would usually go up and assess the situation in case the patient ended up getting transferred to the unit.

However, if you are in a place that does not have a residency program, I can understand the problem. Those situations should probably have a hospitalist or some other medical attending present.

P.S. Jet, can you post a picture of a gravid fire ant. With all these references to one, you've got me curious. 🙂

 

[Apollyon]

We are best trained for these situations...I would say better trained than the ER docs are...they'll argue that point though

Attending

You are correct, sir. They could argue, but they would be wrong.

Resident


Quite the difference. As an EM attending, the senior guys here know I respect the hell out of them. And I know where my place is at (and isn't). There is NO WAY I would want a post-op heart on milrinone and amiodarone drips with a rhythm that changes with every quiver of the puckered *******s in the room.

At the same time, I'm down stairs in "the pit", working the code that EMS has worked over, with half the information, half the people (which is quite a benefit), and just doing down and dirty ACLS.

And, along with the respect, I get so many new perspectives and ideas that help me help the patients before someone else messes them up before they get to you. We're just different buildings on the same street.

 

[coprolalia]

Resident

Right. Most of the lip I get is from EM residents. I've had attendings call me to help put the tube in, run the code, etc. The attendings seem to know their limits more than the residents do.

Thank you for clarifying.

-copro