Last 5 minutes of CCS cases

[Seldon1985]

---

Members don't see this ad.

Hey everyone,

Question. During the last 5 minutes of your CCS cases, what sort of orders are you canceling, adding, or in general doing? Even after I read the CCS explanations, there aren't a whole lot of things to add during this time. If my patient is still in the hospital, you wouldn't cancel IV, IV drugs, change to PO, etc right? Even if you wanted to do this once the patient got better at a future date, you can't predict which date he would be better to send home, right? I'm confused as to how I should approach these last 5 minutes... Thanks!

 

[IMdocT]

when i took the test i also assumed that if the patient was still in the hospital and wasn't ready to be discharged, but was on the right management, i didn't discontinue everything. it seemed to me that when the case ended, most of the things that were supposed to be done were already done. most of the orders i added were counseling orders. the ones i discontinued were in an ER case when the patient was likely recovered and about to go home, so i basically got rid of everythign and added counseling. remember to decide if their home medications should be continued or not. it didn't happen to me, but in some scenarios, you're supposed to discontinue home medications right away, especialy if you think they contribute to the top ddx. i need 1.5 more weeks for my score to come back

 

[Seldon1985]

got it, so you'd deal with the patient's current condition and add/delete orders according to that. thanks!

 

[OveractiveBrain]

Hey everyone,

Question. During the last 5 minutes of your CCS cases, what sort of orders are you canceling, adding, or in general doing? Even after I read the CCS explanations, there aren't a whole lot of things to add during this time. If my patient is still in the hospital, you wouldn't cancel IV, IV drugs, change to PO, etc right? Even if you wanted to do this once the patient got better at a future date, you can't predict which date he would be better to send home, right? I'm confused as to how I should approach these last 5 minutes... Thanks!

The "last 5 minutes" should not be the actual last 5 minutes.

If you have done everything the right way, ordered the right tests, given the right intervetnions, then the test will end early. If the case ends early, you win. Stop. Dont do anything else. You've already won. This is not a test that investigates your discharge planning or your followup. That "last 5 minutes" is for people who are failing the case, who havent done the right thing in 25 minutes, and have one last opportunity to do the right thing. If this is you, prepare more. You are failing.

If, on the other hand, you get that screen 5-10 minutes in, you've already won. So dont enter anything.

 

[hot sauce]

I mostly just made sure I hadn't forgotten any relevant education orders. For the most part it didn't feel like there was much to do in that 5 minute window.

 

[jok200]

usually i do some followup labs like cbc, bmp, urinalysis that i want done a week or so after they leave the hospital, just so I can check up on them. Mainly I counsel the **** out of them and order corny stuff like influenza vaccine or something like that. Overactivebrain is correct though, if you end in 5 or 10 mins and that screen pops up, you have won.

 

[ARB1981]

just to clarify, the case cannot "end early" without getting the 5 minute screen right? So even if you managed the case correctly, and very quickly, you will still get the 5 minute screen?

 

[IMdocT]

Yes, all cases end with the 5 minute screen, either from reaching the endpoint of the case or from running out of time. note that reaching the end of the case can still be poorly done by ordering inappropriate things or not ordering tests and treatments at the right time

 

[OveractiveBrain]

Yes, all cases end with the 5 minute screen, either from reaching the endpoint of the case or from running out of time. note that reaching the end of the case can still be poorly done by ordering inappropriate things or not ordering tests and treatments at the right time

You have to literally KILL the patient for this to be true. Like order a brain biopsy for an appendicitis, and even then, the screen just says "patient refuses" and you keep going. It is almost impossible (I suppose if you were trying to fail, you could) to get an early screen from doing the WRONG thing. If you are trying to do good by the patient, trying to beat the case, the only time it will end early is after you have succeeded.

 

[hot sauce]

You have to literally KILL the patient for this to be true. Like order a brain biopsy for an appendicitis, and even then, the screen just says "patient refuses" and you keep going. It is almost impossible (I suppose if you were trying to fail, you could) to get an early screen from doing the WRONG thing. If you are trying to do good by the patient, trying to beat the case, the only time it will end early is after you have succeeded.

I don't know if I would go that far. Ending early generally means you did everything you needed to but you could still have a sub optimal score if you ordered unneeded tests or delayed the dx (in case time) or left out parts of management. As an example say you get a CP pt in emergency that has a stemi but you wait for a chest CT to come back before sending him to cath lab and you don't give him asa, nitro, ect. Okay those are pretty obvious errors that you shouldn't be making but you can lose a lot of points even if you eventually get the dx and correct final management thus ending the case if you miss important steps steps on the way, delay dx, or are excessively invasive / wasteful.

I don't know how the test is scored exactly but the materials seem to suggest it is a lot about the process in addition to getting the right answer in the end.