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I'll defer to @pkwraith for the details, but that's not how I read the post. What I read was that the hospitalist was asked to take transfer from St. Elsewhere on behalf of the urology service and said that the transfer needed to be evaluated by the ED first. Now, that scenario is moderately defensible, especially because the patient likely would have rotted away before somebody came to see him if it was a transfer straight to the floor.
That's how I read it. Hospitalist wanted patient to go from other hospital to his/her ER for evaluation so he/she could figure out whether to place patient in ICU, floor, etc.
ED is ICU level care. Going from floor to ICU with no available ICU beds is a nightmare. Usually a rapid response nurse has to sit with the patient in a regular room tying up the rapid response nurse for other things.
I’m not a hospitalist but as IM to be honest if I got a call about a patient and the other end of the phone sounded clueless I would trust you guys to get the basic situation sorted out better than us.
Legit and reasonable question. And it shows how long it's been since you've been upstairs.
I'm not being adversarial either...and I don't think you are. I hope you never have to go upstairs. But its a different world up there and it might help to understand it a bit better as it will help you understand why stuff like this happens. That was all I was trying to get at. Your frustration and annoyance is completely reasonable.
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Total tangent, fell free to ignore...an NG won't solve an SBO, of course, but if you have a tense belly from an SBO that is getting close to abdominal compartment syndrome, then decompressing the bowel with an NGT can very much help perfusion.
I don't disagree at all. However, wrt the case in question:
As someone who is paid entirely based on revenue generated, I absolutely love those patients. The patient knows they're going to the ED to be admitted. The accepting doc has pre-accepted them. There're rarely any diagnostic landmines. 1 minute of saying "Hi, I'm Boardingdoc, and I'll be getting all your preop stuff ordered and get you admitted." Lvl 5 chart. Everyone involved in the process is happy. Next.
It's also because "boardingdoc" refers to what you do outside of work, not what you do in your ED. 😉
I'm not referring to a transfer, I'm referring to a surgeon or whoever sends a patient in from home to the ED for admission instead of arranging for them to be directly admitted. There's only 1 ED visit in that case.
What I've heard from a few groups, utilizing different billing companies, is that insurance will only pay one bill per group. So if you transfer a patient to your same group at a different hospital, only 1 bill gets paid. However, if a different group transfers the patient to you, both can bill.
Not correct.
Our psych team has done the same ****. I typically review all of their records and if they are calm and cooperative, no SI/HI currently, and were voluntary psych admits or were extremely questionable whether they ever needed to be admitted to psych to begin with (usually drunkicidle or meth psychosis), I tell psych they either take them back immediately or I’m discharging them. Usually I’m discharging them.
The 2 hospital systems I have privileges at are changing their rules on Jan. 1 to no longer preemptively swab asymptomatic patients admitted for non-respiratory/infectious issues or pre-procedural. We're basically just adding COVID to the "Universal Precautions" list, which I think is a step in the right direction.
That's not true, right? I mean the part about obs?
Thought about it, and that was the original plan. But it was going to keep happening every 12 hours until the nurse got back off vacation, figured it would be easier on all parties just to board in the ED
That’s crazy. Around here even firefighter-basic medics are allowed to give people their own meds , so it seems like a bailiff should be able to as well - I could see sending them in once to confirm those meds are appropriate and safe for the person. Like 98% of med doses are administered by non medical people , to themselves and family members.
I’d probably just write a note, OK to be off metformin for 48 hours.
Yep. My most recent one. Patient sent from an hour plus away.. CC priapism. He tells me “urology said you can probably do this but they can come in if you cant”
Barely related tangent, but trimix kinda amuses me. First 10 years of my career I never saw it used once. Nowadays I send 1-2 patients per month to urology to talk about it. Apparently 20 years of uncontrolled diabetes, smoking, and 17 HTN meds will overpower even the heftiest dose of Viagra.
I also learned to drain them. this seems less common now.
I was trained to drain them, as well, although I guess I’m on the tail end of being new school being a PGY-11. It’s so easy though. I literally had one of my med students perform the procedure a few weeks ago.
A favorite from my trauma center days. Pre transfer diagnosis; Comatose after fall, blown pupil.
PGY 28 here who trained at shock trauma. We drained them every day and all day. Did Paracentesis, thoracentesis, and other stuff in the ER then discharged regularly.
We drained these and in residency and I drain them in the community. Newer docs and PAs seem to CT these frequently. Occasionally a PA has already done CT and called ENT before telling me and informs me ENT recommended IV abx and steroids and they'll see them on the floor tomorrow.
ENT does not want to come into the ER to do a 5 min procedure at night + ER doc not comfortable doing PTA drainage = Admission + 50K bill + 5 min procedure tomorrow.
What? So do they just admit for ortho tomorrow or do they splint/send home/ortho tomorrow in clinic?
Your medical group doesn't do basic EM procedures?
Wow. The docs in your group sound like incompetent idiots. That or they're lazy to the point of malpractice. I mean, you could try to sugar coat it, but it's one or the other. Lazy and/or incompetent. Either way it's embarrassing.
