Getting Labs for the Admitting Guys

[docB]

I was listening to Billy Mallon yesterday on this year's LLSA prep stuff and he was talking about whether or not he'd order osms on a kid with DKA. It got me thinking about some of the stuff I do and don't order because someone else will want it.

For example, I usually don't order osms and A1Cs and Lipids on people although I know the admit team will. I do order anemia panel stuff for the anemic patients because if they get their blood before the panel is drawn I've screwed the work up.

In general I'm happy to order anything they want. I put it on the admit orders and write "results to Dr. Admit."

But as we get more and more pressure on the resource utilization side and the liability side I'm getting more reluctant to order this stuff.

Do most EPs order stuff like that?

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[deleted109597]

I try not to. In residency we were actively discouraged from doing so not because of utilization review, but because of the followup process. Our "fast track" docs had to f/u any abnormal lab, got little flags even for admitted patients. So even things that I thought might be intellectual I was told not to do so.

As for my real job, generally I order the few things I don't want to screw up for the docs. Anemia panel is about it. If the admitting docs want quantitative serum ketones, or osms, or whatever, they can order it.

 

[Apollyon]

As for my real job, generally I order the few things I don't want to screw up for the docs. Anemia panel is about it. If the admitting docs want quantitative serum ketones, or osms, or whatever, they can order it.

You've been an attending for a little more than a month so far, right?

"Collegiality" is a big part of it.

 

[tkim]

Do most EPs order stuff like that?

If it's something the hospitalists want and not a big deal to do, I order it. Grease the wheels.

 

[Apollyon]

If it's something the hospitalists want and not a big deal to do, I order it. Grease the wheels.

Exactly. If you're the new guy, and the first impression is that you're a hard-ass, well, if that's what you want, you'll get it.

 

[deleted109597]

You've been an attending for a little more than a month so far, right?

"Collegiality" is a big part of it.

I don't disagree, and it comes across in a manner I wasn't intending to project entirely. However, I haven't been asked to order stuff by them, and I wouldn't flippantly tell them no if they did ask.
I'm also not a mind reader.

 

[TysonCook]

If they're being admitted, and its not a send out I will order basic stuff. But for us, if the consultant wants the lab, they must write it on their own order set.

For people going home, I order it under their doctors name and results to him/her.

Not so much utilization review stuff, but call backs, redraws, patient wanting results, medmal, etc.

 

[dchristismi]

I'll do the basic preop stuff for my hip fractures, but let them order their own cholesterol and anemia panels.

If they ask for something specific med-wise, I will usually oblige as it gets done faster (different abx, the 2b3a inhibitor du jour, etc)
They generally just order what they want when I hand them off to the nurse for orders. (95% of ours are given verbally to the nurse - even if they're in the department, which annoys the crap out of the nurses.)