ED Stalking

[Perrotfish]

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Does anyone else here stalk the ED? You know, look through the ED stat board on Essentris, to figure out who you're going to get called on? Even though you can't do anything about it.until they call anyway? Its a great way to drive yourself nuts, especially as a resident on call.

The point is, that's how I feel watching the news these days. Who thinks we're going to Gaza?

 

[UltimateDO]

Totally did this is a resident when in the unit or on wards, in fact we would take bets on who we were gettting called on. Seniors always had the advantage of knowing the freq fliers though 😛 My bet regarding your second questions unfortunately is going to be North Africa. Gaza is a political powderkeg and the IDF are more than capable. The current situations in Mali and Somalia are much more in line with the current GWOT effort.

 

[Gastrapathy]

Don't do that at civilian hospitals. Its a privacy violation Until you're consulted, you have no business in the chart.

 

[DD214_DOC]

I monitor the ED just to see anyone presenting with a psych cc. Sometimes, if I know I'm going to get called, I will go down and see the patient before the ER doc even sees them just to get it over with. I can do a psych eval in 15-20 minutes but it's usually 3-5 hours from triage to consult otherwise.

 

[UltimateDO]

I monitor the ED just to see anyone presenting with a psych cc. Sometimes, if I know I'm going to get called, I will go down and see the patient before the ER doc even sees them just to get it over with. I can do a psych eval in 15-20 minutes but it's usually 3-5 hours from triage to consult otherwise.

Agreed, #1 if they are a MICU player I would rather get to them before the ED has their way with them. #2 if we were near shift change an it looks like the ED staff is going to call up 4-5 consults together right before they leave I would rather get them up to the ward and allow myself / resident time to get orders / H&Ps in due to work hour rules.

God help us if we complain about the ED staff doing these things since our DCCS was EM. 🙄

 

[met19]

As an ED doc- I have to agree with Gastrapathy- its a privacy violation and I would be careful about initiating orders or doing consults prior to the ED eval- there's a reason EM exists.

And just like other services we appreciate a friendly thanks when we help you (after all we appreciate your consults, admissions, and quick follow ups when we try to arrange them). But also like other service, please don't step on our toes. Its rude and not professional.

 

[DD214_DOC]

As an ED doc- I have to agree with Gastrapathy- its a privacy violation and I would be careful about initiating orders or doing consults prior to the ED eval- there's a reason EM exists.

And just like other services we appreciate a friendly thanks when we help you (after all we appreciate your consults, admissions, and quick follow ups when we try to arrange them). But also like other service, please don't step on our toes. Its rude and not professional.

It's also rude and unprofessional to have a psych patient in an eval room for 5 hours then calling a consult at 11PM because the patient is, "sad and wants to talk to someone, but there are no safety concerns".

 

[met19]

It's also rude and unprofessional to have a psych patient in an eval room for 5 hours then calling a consult at 11PM because the patient is, "sad and wants to talk to someone, but there are no safety concerns".

Who knows why that consult was called? Yes waiting 5 hours re😛atient care is wrong. maybe the EP had concerns- he/she should've told you them. I'm sure there is more to that story than is being relayed. But if that is you're reason for stalking the ED essentris.....

But my point is doing a consult prior to being called can leave you very liable if something goes wrong. There are reasons why patients are sent to the ED rather than directly admitted to wards.

I admire consultants who ask appropriate questions, assist in making dispositions, and have a professional demeanor (even if they are stalking essentris)- not implying you don't- just saying what makes my encounters pleasant.

 

[DD214_DOC]

Who knows why that consult was called? Yes waiting 5 hours re😛atient care is wrong. maybe the EP had concerns- he/she should've told you them. I'm sure there is more to that story than is being relayed. But if that is you're reason for stalking the ED essentris.....

But my point is doing a consult prior to being called can leave you very liable if something goes wrong. There are reasons why patients are sent to the ED rather than directly admitted to wards.

I admire consultants who ask appropriate questions, assist in making dispositions, and have a professional demeanor (even if they are stalking essentris)- not implying you don't- just saying what makes my encounters pleasant.

Nope, there is no missing information. That's just the climate in our ED. I used to press and ask pertinent questions and suggest that, based on the information, something like outpatient follow-up would be more appropriate. Usually I just got yelled at and told that psych patients are my job. Crap like this is why I am pushing to have a psych ER and a dedicated resident/staff to cover psych stuff from triage to dispo and bypass the regular ED unless indicated.

Despite what people think, studies show that shrinks are no better at, "predicting" suicidal behavior than any other physician, teacher, janitor, or joe schmoe on the street.

 

[pgg]

Don't do that at civilian hospitals. Its a privacy violation Until you're consulted, you have no business in the chart.

No different at military hospitals. AFAIK the only HIPAA exception for the military is that information can be released to the patient's CO in order to facilitate readiness or operational decisions affecting that patient or the unit. I don't see how browsing the EMR to see how busy your night might be falls under that exception.

This isn't even a gray area. Suppose you're browsing, and you recognize the name of someone you know and see 'rectal foreign body' in the chief complaint box ... How can you possibly justify having that information? You can't un-see it. It doesn't help you do your job. You're not triaging OR cases in a Role II tent based on what's in the ER bays ... you're bored.

Who thinks we're going to Gaza?

Seriously? Not a chance.


You didn't ask, but we're not going to attack Iran either. They'll get their nuclear bombs and we'll deter them the same way we did the Soviets. I know, not very exciting. 🙂

 

[corpsman33]

No different at military hospitals. AFAIK the only HIPAA exception for the military is that information can be released to the patient's CO in order to facilitate readiness or operational decisions affecting that patient or the unit. I don't see how browsing the EMR to see how busy your night might be falls under that exception.

This isn't even a gray area. Suppose you're browsing, and you recognize the name of someone you know and see 'rectal foreign body' in the chief complaint box ... How can you possibly justify having that information? You can't un-see it. It doesn't help you do your job. You're not triaging OR cases in a Role II tent based on what's in the ER bays ... you're bored.




Seriously? Not a chance.


You didn't ask, but we're not going to attack Iran either. They'll get their nuclear bombs and we'll deter them the same way we did the Soviets. I know, not very exciting. 🙂

Not that I think we are going to invade Iran anytime soon, but I think Iran has more desire to use nuclear weapons against Israel then the Soviets ever had for using them. And whether we get involved or not, I believe Israel will get involved which will certainly change the international political dynamic.

 

[DD214_DOC]

Not that I think we are going to invade Iran anytime soon, but I think Iran has more desire to use nuclear weapons against Israel then the Soviets ever had for using them. And whether we get involved or not, I believe Israel will get involved which will certainly change the international political dynamic.

Unfortunately you cannot see the patient you're actually consulted on without opening the EMR and seeing everyone who's in the ER

 

[pgg]

Not that I think we are going to invade Iran anytime soon, but I think Iran has more desire to use nuclear weapons against Israel then the Soviets ever had for using them. And whether we get involved or not, I believe Israel will get involved which will certainly change the international political dynamic.

I'm just a guy on the internet, but of all the things in the world that worry me, Iranian nuclear weapons and Israel attacking Iran aren't among them.


The clerics have been in power for decades. They may be jerks, but they're cold calculating jerks who like being in power. Just like the Soviets.

Israel blew up an un-hardened Iraqi reactor within easy round-trip flight, not requiring midair refueling. They simply lack the capability to hit hardened targets that far away without help, and we're not going to help. Supposedly, one of their criteria for bombing the Osirak reactor was to hit it before it was fueled to avoid radioactive contamination. Iran's sites already have nuclear material.

Israel can't (won't) even put a violent end to Hamas, and those guys are right there in Gaza, actively tossing rockets at Israel every day. Israel is very sensitive to the political costs and international reaction to what they do. They're saber rattling. They're not going to attack Iran.


Pakistan is a bigger problem.

 

[pgg]

Unfortunately you cannot see the patient you're actually consulted on without opening the EMR and seeing everyone who's in the ER

There's a world of difference between poking around an EMR because you're bored or curious, and incidentally seeing something in the course of doing your job.

 

[jabreal00]

I rarely stalked the essentris ED board as a resident, unless it was close to change of shift for me. I never saw any ED patients prior to being consulted and discouraged the ED staff from giving me "heads up." I'd cut them off and say once your are ready to consult call me back.

 

[Doctor Bob]

I rarely stalked the essentris ED board as a resident, unless it was close to change of shift for me. I never saw any ED patients prior to being consulted and discouraged the ED staff from giving me "heads up." I'd cut them off and say once your are ready to consult call me back.

This is something that I try to do, and I'm getting the impression from the consultants at my shop that they'd rather I not do it.

When I have a patient who, through history and physical, will need a consultation from a specialist, I try to call them and let them know the patient is here. I do it in a timeframe such that by the time they arrive, all of the labs/scans will be resulted. I do it so that the "consult clock" (the time in which a consultant has to come to the bedside after receiving the call) does not start and so they can come down when they have a free moment. It is done with the intention of allowing the consultants more time-management freedom. In the civilian world it was met with much gratitude from my consultants. I've found it's met primarily with hostility in the military world.

I have seen some colleages use the "heads up" call inappropriately (e.g. calling without a presumed diagnosis, without clear physical exam/historical findings, etc). Maybe that's colored some of the consultant's opinions.

 

[Kingfisher]

Suppose you're browsing, and you recognize the name of someone you know and see 'rectal foreign body' in the chief complaint box ...

If I happen to "fall" on a flashlight while taking a shower at 0200 and show up to MY hospital ED....I deserve what's coming