I'm thinking about taking a job that requires you to have to run codes on the floor. I have never had to do this before. I also don't quite understand why the MDs upstairs can't do this themselves. I would love to have a non site director sales pitch answer to my questions so Im posting here. For any of you who have to do this at your job, is it a pain or an issue to have to respond to codes? Does it happen frequently? I'm assuming it would tie up the ED if you have to leave, and what if someone in the ED is really sick? I also get really winded running upstairs. Should this be a deal breaker? Thanks in advance.
Having to run codes on the Floor
- Thread starter prolene60
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We run the floor codes where I work. I imagine it's somewhat common. To be honest, I find it to be a perk, because it's pretty much a guaranteed sick patient, and I'd prefer to run a code than take care of the tenth nonspecific belly pain. Also, I get RVUs for floor codes.
You ask why the docs upstairs can't do it... well, because sometimes there aren't docs upstairs.
In the community, outside of the pulm/CC docs, nobody else wants to run a code. If I go to a code during the day, the hospitalist immediately defers to me if they're there. And at night, the ED doc is usually the only one available. It can be as short as 2 minutes (they're dead), as long as 30, but typically 10-15. Then I run back to the department.
It interrupts your flow, sure, and some of the other docs do mind more than me. If it's during a time you're double covered, it's not as big a deal. I haven't had a floor code interrupt me taking care of a sick person in the ED, but I'm sure that will end up happening at some point. As far as how often I do it... I'd say once every 2-3 shifts.
You ask why the docs upstairs can't do it... well, because sometimes there aren't docs upstairs.
In the community, outside of the pulm/CC docs, nobody else wants to run a code. If I go to a code during the day, the hospitalist immediately defers to me if they're there. And at night, the ED doc is usually the only one available. It can be as short as 2 minutes (they're dead), as long as 30, but typically 10-15. Then I run back to the department.It interrupts your flow, sure, and some of the other docs do mind more than me. If it's during a time you're double covered, it's not as big a deal. I haven't had a floor code interrupt me taking care of a sick person in the ED, but I'm sure that will end up happening at some point. As far as how often I do it... I'd say once every 2-3 shifts.
I've had to do it once every few months, fortunately only seems to happen during double coverage time. I don't like doing it honestly, but sometimes I'm the only one really available able to run codes and intubate when **** hits the fan.
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We have to respond to floor codes during non-nighttime hours (we have a nocturnist, although they still will call us if they can't intubate). The ICU is almost as far away as it could physically be from the ED, so it's a ~2.5 min run with 3 flights of stairs. They aren't common (maybe every 4 shift), and probably have the time we get disregarded as soon as we get there because the intensivist is already up there. I have been stuck in a code for 90 min because none of the patients doctors where calling me back to come in and assume care (I'd already tubed and lined the pt), but the majority are in the 15-20 min range. As long as it's just codes and you're not the line monkey for the hospital (also find out if your hospital has RRTs and if so who goes to them), you're probably fine. I look at in-house codes similar to writing admit orders. They both pull me away from my core tasks and I'm sure ACEP frowns on both practices. In an ideal world I wouldn't have to do either, but at least I get reimbursed for the codes.
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We also go to codes. If the hospitalist is there, we leave. If they're eating dinner at home, we run it. I probably go once a month and have been "the doc" maybe once a year. Just one of the prices of community practice. And yea, we bill for it.
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We have to do it after hours at the VA, as we're the only attending in house - and the only person allowed to place the airway (anesthesia "backup" is at home asleep with 60min to get in if called).
Sometimes aggravating, as I have to leave the ED regardless of whatever impending disaster is brewing (short of me coding someone else down here)... but also fun because, hey, it's a sick person.
-d
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Sometimes aggravating, as I have to leave the ED regardless of whatever impending disaster is brewing (short of me coding someone else down here)... but also fun because, hey, it's a sick person.
-d
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On a related note, has anyone come across a hospital where you have to run for "blue baby" codes, immediately post-delivery? One of the places that I'm looking at to moonlight requires you to run for these codes if they happen overnight because you are the only doc in house and the midwives are delivering by themselves. NICU attending is a good 30 mins away.
I don't think my rectum could take the pucker exponent for that (at least not yet).
I don't think my rectum could take the pucker exponent for that (at least not yet).
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We do it at my hospital, happens more than I'd like. I personally hate it. Sure, it's an opportunity to take care of a sick patient, but I have sick ones in the ER too, and we are very busy. It's not safe for patient care to be pulled away from the department.
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I would not take this job. Having significant responsibilities outside the ED takes us outside our scope of practice and opens you to significant liability. Just say no.
only at one of my group's 7 sites... the most rural hospital. hasn't happened to me yet.
to those who do respond to floor codes: is it like residency, where at least half of "floor codes" are not really a code??
to those who do respond to floor codes: is it like residency, where at least half of "floor codes" are not really a code??
D
deleted109597
Nope, they're really codes.
Or the "RT failed semi-elective intubation," which is always fun.
When I was single coverage, these really scared me. What scared me more was one day (I wasn't working), the ED doc went upstairs in the morning for a code. Shortly thereafter, an ambulance brought a code in. The hospitalist worked the code in the ED, and the EP worked the code upstairs. Tell me if you see a problem with that.
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Great replies.
The above is pretty much how it is at my shops. I don't view it as a perk because I'm always too busy in the ED to run upstairs. I do get paid for it. It adds additional litigation exposure which is a problem.
When there's a code in the ED and on the floor at the same time my obligation is to the ED first. However I've never seen a primary doc come in for a code so if I can't go to the floor code immediately the nurses will just do ACLS until I get there. So I have to go eventually no matter what.
Agreed. I do codes and all the in house tubes but not the lines. Although we get called about those a lot. Frighteningly we now have a policy that we also have to handle all the in house lacerations and nose bleeds. Our internists don't do much with their hands.
We don't do this. I would be afraid as well.
In Las Vegas 90% of the EM jobs require going to floor codes. If you want to work in many towns it's not a choice.
Agree with McNinja, they're real codes. Nurses can get away with calling residents for anything. Attendings with a busy ED downstairs will walk out on a syncope telling the nurse to call the PMD.
We run the floor codes where I work. I imagine it's somewhat common. To be honest, I find it to be a perk, because it's pretty much a guaranteed sick patient, and I'd prefer to run a code than take care of the tenth nonspecific belly pain. Also, I get RVUs for floor codes.
You ask why the docs upstairs can't do it... well, because sometimes there aren't docs upstairs.
It interrupts your flow, sure, and some of the other docs do mind more than me. If it's during a time you're double covered, it's not as big a deal. I haven't had a floor code interrupt me taking care of a sick person in the ED, but I'm sure that will end up happening at some point. As far as how often I do it... I'd say once every 2-3 shifts.
The above is pretty much how it is at my shops. I don't view it as a perk because I'm always too busy in the ED to run upstairs. I do get paid for it. It adds additional litigation exposure which is a problem.
When there's a code in the ED and on the floor at the same time my obligation is to the ED first. However I've never seen a primary doc come in for a code so if I can't go to the floor code immediately the nurses will just do ACLS until I get there. So I have to go eventually no matter what.
Agreed. I do codes and all the in house tubes but not the lines. Although we get called about those a lot. Frighteningly we now have a policy that we also have to handle all the in house lacerations and nose bleeds. Our internists don't do much with their hands.
We don't do this. I would be afraid as well.
In Las Vegas 90% of the EM jobs require going to floor codes. If you want to work in many towns it's not a choice.
Agree with McNinja, they're real codes. Nurses can get away with calling residents for anything. Attendings with a busy ED downstairs will walk out on a syncope telling the nurse to call the PMD.
