Inpatient Pediatrics cases

[ztaw15]

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How do FM guys in private practice - ones who still do inpatient/outpatient stuff - handle pediatric cases that need to be admitted. This is probably the one thing I came out of my FM rotation not understanding, as we really didn't see any kids in the office that needed to be admitted. Do the still do the inpatient management on these cases (assuming they aren't needing crazy PICU stuff, etc.)? I don't see why this wouldn't be the case, and I can't imagine a group contracting with a pediatrics group for just the admissions, but I don't know.

How is this done in practice?

 

[diphenyl]

All kids at my shop get admitted to a peds hospitalist- unless their pmd is a pediatrician. Not a hospital policy per say, just no family med guys around here admit their kids

 

[cabinbuilder]

When I worked in a rural critical care access hospital and I had a peds patient that needed admitting, I put them in the hospital myself.

Currently since I don't have hospital priviliges anywhere, if a sick kid comes through the office I have no choice but to send them to the ER for evaluation since there really aren't any pediatricians where I work either.

 

[Shinken]

How do FM guys in private practice - ones who still do inpatient/outpatient stuff - handle pediatric cases that need to be admitted.

I use the pediatric hospitalists at my local hospital. My adult admissions are handled by the adult hospitalists.

I still have to occasionally round in the hospital (maybe once every other month or so), when my nursing home patients have to be admitted for inpatient treatment, since the adult hospitalists at my hospital won't take nursing home admissions, only my private patients. That way I keep my inpatient skills current for adults (I'm not interested in pediatric inpatient skills due to the liability - similar to why I don't do OB).

 

[EdibleEgg]

I use the pediatric hospitalists at my local hospital. My adult admissions are handled by the adult hospitalists.

I still have to occasionally round in the hospital (maybe once every other month or so), when my nursing home patients have to be admitted for inpatient treatment, since the adult hospitalists at my hospital won't take nursing home admissions, only my private patients. That way I keep my inpatient skills current for adults (I'm not interested in pediatric inpatient skills due to the liability - similar to why I don't do OB).

To the OP, I still admit kids, it's just a very small part of my practice. Peds is less than 20% of my practice, and they just don't get sick that often. I will have to say that I'm pretty quick to transfer, but then so are the pediatricians here.

Shinken, I don't understand your situation. Why do you use the hospitalists at all if they won't admit your NH patients? I'm generally not in favor of giving up my patients or privledges. However, I some times do want to take a nine iron to my pager. It seems you have the worst of both worlds.

 

[ztaw15]

Thanks for all the replies.

 

[lowbudget]

I admit my own kids and take call. My community hospital doesn't have a PICU, however so I'll refuse admission if it requires (or potentially requires) a higher level of care. That said, I've never had problems with a stat transfers (*knock on wood) even if they are uninsured.

My clinic patients rarely-to-occasionally get admitted, but not frequently. I would like to think it's because I'm doing a good job, but who the hell knows. I doubt it. We have late hours and Saturday hours, so I think that cuts down on our/my admissions. When I take call for admissions, most of my kids are poor (uninsured or Medicaid).

 

[Shinken]

Shinken, I don't understand your situation. Why do you use the hospitalists at all if they won't admit your NH patients?

Long story short, if they take my nursing home patients, then they would need to take the patients of the other docs that go to that same nursing home. Currently they don't have the manpower to handle that. They plan on increasing their numbers so they can handle the increase in volume (before the end of the year). Until then, I go to the hospital to care for my nursing home folks. Overall I have to round on 1 or 2 patients every 2-3 months so it's not as bad as it sounds. When you factor in the other doc's patients it adds up (I'm the doc that has the least number of residents at that nursing home).